Secondary Intention Healing Over Exposed Bone on the Scalp, Forehead, and Temple Following Mohs Micrographic Surgery

Removal of skin cancers on the scalp, forehead, and temple can result in surgical defects with exposed bone. In such cases, reconstruction becomes challenging due to limited vascularity for flap or graft repair.

Demonstrate the usefulness of secondary intention healing of scalp, forehead, and temple defects over exposed bone.

A retrospective case series of 41 patients who had Mohs Micrographic Surgery with post-surgical scalp, forehead, or temple defects involving exposed bone. These patients then underwent secondary intention healing.

90% of patients successfully healed. Average time to complete granulation was 92 days, and average time to full re-epithelialization was 186 days. Visual analog scale assessment of final scar quality resulted in 57% being good, 35% being fair, and 8% being poor. No patient had infection or other serious complication. Mean follow-up duration was 272 days.

This case series shows the viability of secondary intention healing of scalp wounds over exposed bone. Study power was not adequate to predict time to complete healing based on defect size, or allow association of patient factors with the risk of nonhealing. Managing patient expectations, and emphasizing the importance of early occlusive wound care is paramount for healing success.