Secondary intention healing in lower eyelid reconstruction--a valuable treatment option

Secondary intention healing--or laissez-faire technique--is the first rung on the reconstructive ladder but may often be overlooked in favour of more elegant reconstructive options. Whilst the nose and medial canthus of eye have long been considered suitable sites for secondary intention healing, most plastic surgeons would hesitate to employ this technique with full-thickness lower eyelid wounds. There are currently no reports in the plastic surgery literature advocating its use, but the technique is gaining credence in the field of oculoplastics as a genuinely useful alternative to formal reconstruction. Four cases are presented where tumours excised from the lower eyelid were allowed to heal by secondary intention. The largest involved 75% of the lid margin. All were elderly patients in whom formal reconstruction was either declined by the patient or considered unwise by the surgeon. The cosmetic and functional results were quite remarkable, so much so that this technique demands serious consideration as a valuable treatment option, and quite possibly the treatment of choice in elderly or infirm patients whose tolerance of more complicated procedures may be limited.