Secondary Intention Healing of Extensive Nasal Defects: A Multimodal Approach to Optimize Esthetic Outcomes

Area of Science:

• Dermatology
• Plastic Surgery
• Oncology

Background:

• Secondary intention healing (SIH) in nasal defects can have variable cosmetic outcomes.
• Extensive facial defects, such as those from basal cell carcinoma (BCC) excision, often require complex reconstruction.

Purpose of the Study:

• To report a case of successful management of an extensive facial defect using SIH followed by laser therapy.
• To highlight a minimally invasive approach for optimizing scarring and reducing the need for complex reconstructive surgery.

Main Methods:

• A 75-year-old male with recurrent sclerodermiform BCC underwent excision, creating a large defect involving the nose, eyelid, and cheek.
• The surgical defect was managed with SIH and advanced dressings.
• Post-healing, hypertrophic scarring was treated with a combination of intense pulsed light (IPL), fractional ablative erbium laser, and 5-fluorouracil (5-FU) delivery.

Main Results:

• SIH successfully managed the extensive facial defect.
• The multimodal laser and 5-FU treatment protocol led to progressive remodeling of hypertrophic scarring.
• Complete clinical resolution of the hypertrophic component resulted in a nearly imperceptible scar.

Conclusions:

• Early postoperative intervention with a multimodal laser approach can significantly enhance cosmetic outcomes after SIH in extensive facial defects.
• Combined laser technologies and 5-FU offer a minimally invasive strategy for scar optimization, potentially avoiding complex reconstructive procedures.