Second-intention healing of exposed facial-scalp bone after Mohs surgery for skin cancer: review of ninety-one cases.

Abstract

Second-intention healing over exposed bone is considered by some to be subject to the complications of pain, infection, and nonhealing. Our purpose was to determine would healing by second intention over exposed scalp or facial bone after Mohs micrographic surgery for skin cancer. The chart records of all patients treated between 1981 and 1992 for skin cancer that resulted in exposed bone were identified. There were 115 wounds in 91 patients that were managed by second-intention healing, or partial closure, or both. Three cases of soft tissue infection occurred adjacent to nasal and sinus areas. The overall complication rate was 5.4% (6 of 112 cases) and consisted of localized soft tissue infections (2.7%) and poor wound healing (2.7%). There were no cases of osteomyelitis. Second-intention wound healing was successful in 95% of the wounds. The outpatient management of exposed bone after Mohs surgery is relatively safe. Relative risk factors for development of complications include (1) a history of previous x-radiation treatment for skin cancer, (2) manipulation of the operative site, and (3) an open defect located near the nose or exposed sinus cavity.