Abstract
Second intention healing (SIH) is useful for many defects after skin cancer removal.
SIH decreases intraoperative morbidity and reduces procedure costs. Granulating wounds
are rarely infected, have minimal pain or bleeding, and care is simple. Location is
the key determinant in cosmetic outcomes of SIH. Concavities of the face including
the medial canthus and conchal bowl often heal imperceptibly. Defects on convex surfaces
such as the nasal tip and malar cheek can heal poorly with depressed scars. Flat areas
of the cheeks, forehead, and chin heal favorably but cosmesis can be unpredictable.
These regions are often described by NEET (concavities of the nose, eyes, ears, and
temple), NOCH (convexities of nose, oral lips, cheek, chin, and helix), and FAIR (flat
areas of the forehead, antihelix of the ear, eyelids, and rest of the nose, lips,
and cheeks). We review the limited literature describing SIH based on regional anatomy
of the face. Complications of SIH include exuberant granulation tissue, hypopigmented
or telangiectatic scars, and distortion of free lid margins. SIH should be an integral
part of the surgeon's reconstructive algorithm after skin cancer removal.
Keywords
second intention - wound healing - Mohs surgery
