The Efficacy of Second-Intention Healing in the Management of Defects on the Dorsal Surface of the Hands and Fingers after Mohs Micrographic Surgery

Abstract

Second-intention healing is an effective option for repairing defects on the dorsum of the hand and fingers. Large defect size is not a contraindication for second-intention healing.

A prospective case series of secondary intention healing for surgical wounds on the dorsum of the hand

“…Complications such as postoperative pain, bleeding and infection were uncommon. This is in keeping with the low complication rates reported with secondary intention healing at other sites . There were no organisms isolated from the wound swabs taken from the two patients who developed postoperative erythema at the wound edges accompanied by pain.…”

“…Secondary intention healing may also be adopted for wounds at body sites other than the head and neck. Its usefulness has been documented for wounds on the trunk and limbs, legs, plantar surface of the feet, nipple–areola complex, tips of the digits, and the dorsa of the hands and fingers …”

Secondary‐intention healing following Mohs micrographic surgery for squamous cell carcinoma of a finger

“…Therefore, MMS should be considered the ideal therapeutical method for such a location. In cases of a large surgical defect in the distal phalanx of a finger, cutaneous flaps or grafts could be very complex, and secondary‐intention healing appears as an interesting alternative . In addition, the use of hydrocolloid dressings would favour adequate healing and lead to a better aesthetic result…”

“…Mohs micrographic surgery (MMS) has been proposed as the best therapeutical option when there is no bone compromise because it allows the preservation of healthy tissue and increases the chances of success . After removing the tumour, the surgical defect could be resolved by flaps or grafts; however, sometimes these options are not convenient, and the secondary‐intention method could be the best option …”

Secondary Intention Healing and Purse-String Closures

“…A case report also showed that SIH can be used for defects on the dorsum of the hands and fingers with preservation of function so long as the defects did not traverse joints or expose tendons. 12 It should be noted that scar tissue is relatively hypopigmented and avascular and will contrast sharply against skin that is darkly pigmented or has many telangiectasias. Additionally, SIH should be avoided near free anatomic margins, which can be distorted as the wound contracts.…”