title: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Medical Center, Panorama City, Calif, USA.
authors.forename: B C
authors.initials: BC
authors.lastname: Levin
authors.forename: L A
authors.initials: LA
authors.lastname: Adams
authors.forename: G D
authors.initials: GD
authors.lastname: Becker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004428:Ear Neoplasms / Q000473:pathology / Q000601:surgery*; D004431:Ear, External; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery / Q000009:adverse effects / Q000379:methods*; D011182:Postoperative Care; D017592:Skin Care; D013524:Surgical Flaps; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents