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

Abstract

Background: Second-intention healing over exposed bone is considered by some to be subject to the complications of pain, infection, and nonhealing.

Objective: Our purpose was to determine would healing by second intention over exposed scalp or facial bone after Mohs micrographic surgery for skin cancer.

Methods: The chart records of all patients treated between 1981 and 1992 for skin cancer that resulted in exposed bone were identified.

Results: 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.

Conclusion: 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.