Search

For Mohs surgical wounds that show exposed bone (ie, bone denuded of periosteum), healing by secondary intention may be preferable to surgical reconstruction. To determine the appropriateness of secondary intention healing, we reviewed surgical outcome in 205 patients with Mohs wounds of the scalp and forehead that had healed by secondary intention. Of these patients, 38 had Mohs wounds showing exposed bone. The mean area of exposed bone was 1074 mm(2); the mean area of exposed soft tissue was 1575 mm(2). The mean time for wounds with intact periosteum to epithelialize was 7 weeks; the mean time for bare bone to epithelialize was 13 weeks. All wounds healed without infection or tissue breakdown. We conclude that secondary intention healing of scalp and forehead wounds showing exposed bone is a safe and effective method of wound management after Mohs surgery.

Background: Facial defects after Mohs surgery may be closed at the time of surgery, shortly thereafter, or allowed to heal spontaneously. Selection of appropriate management options requires accurate prediction of the final cosmetic result., Objective: To determine the relative merits of treatment options for facial defects resulting from Mohs surgery., Methods: We prospectively and retrospectively analyzed outcomes for 132 wounds of the cheek resulting from Mohs surgery and allowed to heal spontaneously. The cheek was delineated into topographic areas and the wound location, size, and depth were recorded. Patients were observed intermittently, and a final evaluation of cosmesis was made after > or = 6 months., Results: Most wounds in the nasolabial fold and preauricular areas healed with excellent results and half the wounds in the medial area of the cheek healed with good or excellent results. Central and mandibular areas of the cheek healed unpredictably, and results were unsatisfactory for most of these wounds., Conclusion: Final cosmetic results of Mohs surgery in the cheek area can be predicted on the basis of location, size, and depth of the wound, enabling physicians to knowledgeably select the most suitable treatment option.

Accurate prediction of the course of wound healing allows patients with Mohs surgical wounds on the face to be objectively selected either for surgical repair or for spontaneous healing. Parameters affecting wound healing--location, depth and size of wound--were documented at intervals for 135 patients who had full-thickness defects in the forehead after Mohs surgery, which were left to heal by secondary intention. Quality of cosmesis was determined at least four months after surgery. Final cosmetic result was predictable on the basis of wound location, size and depth. Allowing selected Mohs surgical wounds to heal spontaneously offers optimal cancer surveillance, simplified wound care and elimination of reconstructive procedures along with their associated costs and potential complications.

Objective: To evaluate secondary intention healing of full-thickness skin defects of the auricle. Immediate reconstruction of full-thickness skin defects after cancer surgery is an accepted surgical method used to preserve function and to minimize cosmetic deformity. However, healing by secondary intention offers the advantages of optimal cancer surveillance, simplified wound management, and avoidance of reconstructive procedures with their associated costs and potential complications. Accurate prediction of the course of wound healing would allow a rational approach to selection of patients for surgical or nonsurgical repair., Design: We observed 133 patients with full-thickness auricular defects (helix, antihelix, concha, pretragal and tragal area, lobule, and posterior aspect) after Mohs surgery and documented a variety of parameters affecting wound healing, including the location, depth, and size of the wound and use of antibiotics. Patients were examined at intervals and determination was made regarding cosmesis at least 6 months after surgery., Results: All wounds healed by secondary intention within 10 weeks. Analgesics were generally not required. Antibiotics were arbitrarily used in 13% of the patients. Three infections occurred with no permanent disfigurement., Conclusions: The location of the wound in the auricular subunit is predictive of the cosmetic result. Exposed cartilage is not a contraindication for secondary intention healing. Prophylactic antibiotics are not routinely required when exposed cartilage is present. The results of secondary intention healing are often more cosmetically pleasing than those of surgical repair.

Immediate reconstruction of full-thickness skin defects after cancer surgery is a commonly accepted surgical principle used to preserve function and minimize cosmetic deformity. Healing by secondary intention, however, offers the advantages of optimal cancer surveillance, simplified wound management, and avoidance of reconstructive procedures with their associated costs and potential complications. Accurate prediction of the course of wound healing, and thereby the final functional and cosmetic result, would allow a rational approach to selection of patients for surgical or nonsurgical repair. We observed 282 patients with full-thickness perinasal (glabella, medial canthus, dorsum, sidewall, tip, ala, philtrum, alar base, and nasolabial fold) skin defects after Mohs' surgery and documented a variety of parameters affecting wound healing, including location, depth, and size of the wound. Patients were examined at intervals, and a final determination regarding cosmesis and function was made at 6 months or later. We conclude that the most important considerations in predicting the final functional and cosmetic result include location by subunit, followed by size and depth of the wound.