When tissue is removed surgically from the face, such as in skin cancer removal, an open wound (defect) remains. If the defect is very small and superficial, there may be an option to let the wound heal on its own, rather than having it surgically repaired. This natural healing of defects is called secondary intention healing. It may be a good choice for patients who are poor surgical candidates or who are not concerned with an optimal cosmetic outcome. Sometimes, secondary intention healing can actually produce superior cosmetic results. Experienced reconstructive surgeon can help the patient make that decision.
While healing, the wound develops granulation tissue that fills the defect. It is red and granular in appearance. It may take 2-3 weeks to develop this tissue in a setting of a protected moist wound. Epithelial tissue grows rapidly over this granulation bed over 1-2 weeks. If allowed to scab over, this process still continues although slightly slower and not clearly visible. Simultaneously, underneath the surface, fibroblasts form scar tissue that forcibly contracts, narrowing the open wound. The process may take 3-6 weeks to close the wound. Small defects, less than 1cm, can heal as fast as 2 weeks.
Wounds left to heal by secondary intention have a chance of healing with a good cosmetic outcome. This is especially true if these wounds are small, superficial and heal over a rigid surface, such as the forehead or scalp.
Secondary intention healing can also result in poor cosmetic outcome as the healing contracts the wound. This could cause an unsightly retraction of the nasal rim, eyelid, lip, eyebrow, or ear. In fatty areas, this can result in a depressed contour deformity such as in the cheek. Your surgeon can help decide if this choice is appropriate for you.
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