HEALING BY SECONDARY INTENTION OF AURICULAR DEFECTS AFTER MOHS SURGERY

Objective: To evaluate secondary intention healing of full-thickness s kin 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, hea ling by secondary intention offers the advantages of optimal cancer su rveillance, simplified wound management, and avoidance of reconstructi ve procedures with their associated costs and potential complications. Accurate prediction of the course of wound healing would allow a rati onal approach to selection of patients for surgical or nonsurgical rep air. Design: We observed 133 patients with full-thickness auricular de fects (helix, antihelix, concha, pretragal and tragal area, lobule, an d posterior aspect) after Mohs surgery and documented a variety of par ameters affecting wound healing, including the location, depth, and si ze of the wound and use of antibiotics. Patients were examined at inte rvals and determination was made regarding cosmesis at least 6 months after surgery. Results: All wounds healed by secondary intention withi n 10 weeks. Analgesics were generally not required. Antibiotics were a rbitrarily 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 c artilage is not a contraindication for secondary intention healing. Pr ophylactic antibiotics are not routinely required when exposed cartila ge is present. The results of secondary intention healing are often mo re cosmetically pleasing than those of surgical repair.