Healing by secondary intention of auricular defects after Mohs surgery
Abstract
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.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Defects to the concavity of the ear are often excellent candidates to heal by secondary intention.
“Additionally, defects to the concavity of the ear are often excellent candidates to heal by secondary intention.[15][16][17][18][19][20]”
From Ear Reconstruction following Mohs Micrographic Surgery (2024) · cites this paper as [17]
When the perichondrium is involved, healing takes longer, but it does not contraindicate healing by second intention.
“When the latter is involved, the healing takes longer, but it does not contraindicate healing by second intention.15”
From Auricular reconstruction after Mohs micrographic surgery: analysis of 101 cases (2021) · cites this paper as [15]
Secondary intention healing predisposes patients to infection of the conchal bowl.
“secondary intention healing seemed to predispose patients to infection of the conchal bowl, as two studies with considerable sample size found cases of infection, albeit at a low incidence [2,12].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [12]
Secondary intention healing poses a greater risk of infection compared to the revolving door flap.
“Secondary intention healing poses a greater risk of infection, as compared to the revolving door flap [2,3,4,5,6,7,8,9,12,18].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [12]
Overall, the risk of bias for the enrolled case series was low following assessment with the JBI Critical Appraisal Checklist for Case Series.
“Overall, the risk of bias for the enrolled case series was low following assessment with the JBI Critical Appraisal Checklist for Case Series [1,4,5,6,7,8,9,10,12,16].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [12]
The aesthetic outcomes of secondary intention healing are inferior to those of the revolving door flap.
“Likewise, its aesthetic outcomes are inferior to those of the revolving door flap [1,3,6,7,9,12].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [12]
The best aesthetic results were achieved when using the revolving door flap or STSG.
“Although all existing reconstructive procedures yield acceptable aesthetic outcomes, the best results were achieved when using the revolving door flap or STSG [1,3,6,7,9,10,12].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [12]
For secondary intention healing, surgeons reported unacceptable healing with web formation in 14.3% of patients, while an excellent or acceptable aesthetic result was achieved in the remaining 85.7%.
“According to the surgeons, unacceptable healing with web formation occurred in 14.3% of patients, while an excellent or acceptable aesthetic result was achieved in the remaining 85.7% of patients [12].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [12]
For secondary intention healing, Futoryan (1995) reported no infections, while Levin (1996) reported 7.1% and Wines (2001) reported 2.8% postoperative infections.
“Futoryan (1995) [18] reported no cases of infection, while 7.1% of patients in Levin (1996) and 2.8% of patients in Wines (2001) developed a postoperative infection [2,12].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [12]
Levin (1996) reported altered scarring in the form of webbing in 14.2% of cases after secondary intention healing.
“In addition, Levin (1996) reported altered scarring in the form of webbing in 14.2% of cases [12].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [12]
The data in this review on postoperative hemorrhage and cosmesis with secondary intention healing is limited, as only one study reported on each of these.
“Nonetheless, the data in this review on postoperative hemorrhage and cosmesis with secondary intention healing is limited, as only one study reported on each of these; therefore, further investigations are required on this subject [2,12].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [12]
The main issue with secondary intention healing seems to be the risk of infection.
“Postoperative hemorrhage incidence was low, necrosis was nonexistent, and aesthetic outcomes were mostly satisfactory; therefore the main issue with secondary intention healing seems to be the risk of infection [2,12,18].”
From Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review (2023) · cites this paper as [12]
The citation lists haven’t been fetched yet
References 13 · Cited by 65
- Authors
- Levin, B. C., Adams, L. A., & Becker, G. D.
- Affiliations
- Kaiser Permanente (US)
- ORCID
- Adams, L. A.
- Venue
- Archives of Otolaryngology - Head and Neck Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 1996-01-01
- Volume
- 122
- Issue
- 1
- Pages
- 59-66
- ISSN
- 0886-4470 (ISSN-L)
- OpenAlex
- W2094272160
- Cited by
- 65
- References
- 13
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 2 · 2023: 1 · 2022: 4 · 2021: 7 · 2020: 1 · 2019: 5 · 2018: 4 · 2017: 2 · 2014: 1 · 2013: 3 · 2012: 2
- FWCI
- 1.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Otolaryngology - Head and Neck Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Health Sciences › Medicine › Epidemiology › Nonmelanoma Skin Cancer Studies
- Health Sciences › Medicine › Rehabilitation › Wound Healing and Treatments
- Keywords
- secondary intention healing, auricular defects, full-thickness skin defect, Mohs micrographic surgery, ear cancer, wound healing, antibiotic prophylaxis, cosmetic outcome, helix, antihelix, concha, tragus, lobules
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Ear Neoplasms, Ear, External, Female, Follow-Up Studies, Humans, Male, Middle Aged, Postoperative Care, Surgical Flaps, Wound Healing, Mohs Surgery, Skin Care
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
