Vedvyas Chetan, Cummings Patricia L, Geronemus Roy G, Brauer Jeremy A
*Ronald O. Perelman Department of Dermatology, NYU Langone Medical Center, New York, New York; †Eisenhower Medical Center, Rancho Mirage, California; ‡Laser and Skin Surgery Center of New York, New York, New York.
Dermatol Surg. 2017 Mar;43(3):415-423. doi: 10.1097/DSS.0000000000000998.
Recent reports have indicated secondary intention (SI) healing utilization for Mohs surgical defects beyond conventionally accepted indications.
To characterize potentially more expansive guidelines for when SI healing is indicated or appropriate in dermatologic surgery.
A survey study was e-mailed to the American College of Mohs Surgery in 2015. A group of 293 respondents addressed factors influencing decisions to heal surgical defects secondarily.
The most experienced surgeons were significantly more likely to heal deep and larger wounds secondarily. Many surgeons elect SI healing in patients with current or previous wound dehiscence, flap necrosis, or infection; in patients who have undergone skin cancer excisions before, or who are elderly, and; if the lesion was sent for permanent section, or when treating high-risk, large, recurrent, or aggressive tumors.
Broader indications for SI healing of Mohs surgical defects may be appropriate than previously understood. In addition to concave, temporal, periocular, perinasal, and periauricular sites, SI healing may be appropriate for convex sites such as the scalp and anterior lower extremity, deep wounds, and large wounds, as well as wounds with dehiscence, flap necrosis, or infection. Certain patient-specific and lesional factors are also appropriate indications for SI healing.
近期报告显示，莫氏手术缺损的二期愈合（SI）应用超出了传统公认的适应症范围。
明确在皮肤科手术中，何时采用SI愈合是合适的，制定可能更广泛的指导原则。
2015年通过电子邮件向美国莫氏外科学会开展一项调查研究。293名受访者讨论了影响手术缺损二期愈合决策的因素。
经验最丰富的外科医生更倾向于二期愈合深部和较大的伤口。许多外科医生会对当前或既往有伤口裂开、皮瓣坏死或感染的患者；之前接受过皮肤癌切除术的患者；老年患者；病变组织送检做永久切片的患者；以及治疗高危、大型、复发性或侵袭性肿瘤的患者选择SI愈合。
莫氏手术缺损SI愈合的适应症可能比之前认为的更广泛。除了凹陷性、颞部、眼周、鼻周和耳周部位外，SI愈合可能适用于头皮和下肢前部等凸起部位、深部伤口、大型伤口，以及有伤口裂开、皮瓣坏死或感染的伤口。某些特定患者因素和病变因素也是SI愈合的合适适应症。
