Secondary intention healing: an alternative to surgical repair

The choices of wound management are limited to either surgical repair or healing by secondary intention. Use of secondary intention healing is the oldest method, antedating the practice of medicine, but its use has declined since surgical techniques have been developed, refined, and popularized. Now secondary intention healing is used mostly for small superficial surgical wounds, lacerations, abrasions, chronic ulcers, and for wounds created by destructive methods such as electrodessication, cryosurgery, or chemical cautery. These applications are known well to dermatologists, but are less often used by other surgeons except when wounds have persisted after surgical repair, become infected, or result from necrosis of flaps or grafts.Even among dermatologic surgeons the interest in plastic and reconstructive techniques has overshadowed the importance and advantages of secondary intention healing. In the past several decades, only a small number of reports has appeared discussing the use of secondary intention healing for wounds that are traditionally managed by surgical repair.^1–10 These reports “rediscovered” the often amazing cosmetic results that follow secondary intention healing. There remains a reluctance to use this method to its fullest advantage. This is partly due to fear that open wounds heal inordinately slowly with complications of pain, bleeding, infection, and horrible scarring, and partly due to the conceit that our surgical skills are superior to Mother Nature's own way. There is an immediate gratification that occurs after the successful repair of a large wound. This feeling is difficult to sacrifice, especially if the results of secondary intention healing cannot be predicted. This chapter will review the advantages of secondary intention healing and provide a set of guidelines that will enable one to predict the cosmetic results of wounds allowed to heal by this method.