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Secondary Intention Healing after Excision of Nonmelanoma Skin Cancer of the Head and Neck: Statistical Evaluation of Prognostic Values of Wound Characteristics and Final Cosmetic Results

van der Eerden, Paul A. M.D.; Lohuis, Peter J. F. M. M.D., Ph.D.; Hart, A A. M. M.Sc.; Mulder, W C. M.D.; Vuyk, Hade M.D., Ph.D.

Plastic and Reconstructive Surgery: December 2008 - Volume 122 - Issue 6 - p 1747-1755
doi: 10.1097/PRS.0b013e31818a9aaa
Reconstructive: Head and Neck: Original Articles

Background: Most data on secondary intention healing of skin cancer defects in the head and neck are empirical and descriptive. This study statistically evaluates the prognostic value of several wound characteristics and location on the final cosmetic result of skin defects left to heal by secondary intention after tumor removal.

Methods: A chart review of all facial reconstructions using secondary intention healing performed in one center between 1992 and 2001 was undertaken. Patient and wound characteristics were analyzed. For analysis of cosmetic outcome, the most recent photographs of the scars were assessed by three independent raters using a categorical judgment scale.

Results: There were a total of 89 patients with 95 wounds. Forty-three percent of the wounds (41 of 95) healed with an “excellent” outcome. In the univariate analysis, the rating excellent was given more often to scars derived from wounds that were small and superficial and that were located in concave areas of the face, in particular, near the medial canthus and medial cheek. Multivariable logistic regression revealed independent associations of an excellent cosmetic outcome with wound size and contour of wound surface only.

Conclusion: This is the first study presenting statistical evidence of what has been known empirically for a long time: wounds in concave areas of the face that are left to heal by secondary intention have a high chance of healing with an excellent cosmetic outcome, especially if these wounds are small, superficial, and located near the medial canthus and medial cheek.

Zoetermeer, Amsterdam, and Blaricum, The Netherlands

From the Department of Otolaryngology, Lange Land Hospital Zoetermeer; the Departments of Head Neck Oncology and Surgery and Radiotherapy, NKI/Avl Amsterdam; and the Department of Otolaryngology, Gooi-Noord Hospital.

Received for publication November 2, 2007; accepted May 20, 2008.

Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Paul A. van der Eerden, M.D., Department of Otolaryngology, Lange Land hospital Zoetermeer, Toneellaan 1, 2725 KJ Zoetermeer, The Netherlands,

©2008American Society of Plastic Surgeons