Healing by secondary intention is inappropriate for complex defects where multiple tissue layers are missing and structural support is needed. Cosmetic results of a defect healing by secondary intention depend upon the facial region involved. Cosmetically, convex facial surfaces located on the nose, cheek, chin, lips, and helix do not heal as well by secondary intention. At these regions, depressed and hypertrophic scars frequently occur. If healing is impaired, excessive scarring frequently results.
Factors contributing to poor healing often result in scarring.
The following practical guidelines can be used to obtain an optimal wound environment for an incision. Debride necrotic tissue to decrease infection risk. Maintain fresh wound edges along the incision to encourage epithelialization. Irrigate copiously to clean the wound and remove foreign bodies. Irrigation can be performed with normal saline or commercial wound cleanser.