Donaldson Matthew R, Coldiron Brett M
Department of Mohs Micrographic Surgery and Cutaneous Oncology, Mountain West Dermatology, Grand Junction, Colorado.
Facial Plast Surg. 2012 Oct;28(5):497-503. doi: 10.1055/s-0032-1325643. Epub 2012 Oct 1.
Second intention healing (SIH) is useful for many defects after skin cancer removal. SIH decreases intraoperative morbidity and reduces procedure costs. Granulating wounds are rarely infected, have minimal pain or bleeding, and care is simple. Location is the key determinant in cosmetic outcomes of SIH. Concavities of the face including the medial canthus and conchal bowl often heal imperceptibly. Defects on convex surfaces such as the nasal tip and malar cheek can heal poorly with depressed scars. Flat areas of the cheeks, forehead, and chin heal favorably but cosmesis can be unpredictable. These regions are often described by NEET (concavities of the nose, eyes, ears, and temple), NOCH (convexities of nose, oral lips, cheek, chin, and helix), and FAIR (flat areas of the forehead, antihelix of the ear, eyelids, and rest of the nose, lips, and cheeks). We review the limited literature describing SIH based on regional anatomy of the face. Complications of SIH include exuberant granulation tissue, hypopigmented or telangiectatic scars, and distortion of free lid margins. SIH should be an integral part of the surgeon's reconstructive algorithm after skin cancer removal.
二期愈合（SIH）对皮肤癌切除术后的许多缺损修复很有用。二期愈合可降低术中发病率并降低手术成本。肉芽创面很少感染，疼痛或出血极少，护理也很简单。部位是二期愈合美容效果的关键决定因素。面部凹陷部位，包括内眦和耳甲腔，通常愈合后不易察觉。鼻尖和颧颊等凸面的缺损愈合后可能会留下凹陷性瘢痕，效果较差。脸颊、额头和下巴的平坦区域愈合情况良好，但美容效果可能不可预测。这些区域通常用NEET（鼻、眼、耳和颞部的凹陷）、NOCH（鼻、口唇、脸颊、下巴和耳轮的凸起）和FAIR（额头、耳轮、眼睑以及鼻、唇和脸颊其余部分的平坦区域）来描述。我们回顾了基于面部区域解剖描述二期愈合的有限文献。二期愈合的并发症包括肉芽组织过度增生、色素减退或毛细血管扩张性瘢痕以及游离睑缘变形。二期愈合应成为外科医生皮肤癌切除术后重建方案的一个组成部分。
