Predicting outcomes following second intent healing of periocular surgical defects
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ORIGINAL PAPER
Predicting outcomes following second intent healing of periocular surgical defects Nour Kibbi1 · Yulia Khan2 · David J. Leffell1 · Sean R. Christensen1 · Kathleen C. Suozzi1 Received: 1 June 2020 / Revised: 21 July 2020 / Accepted: 31 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Traditionally, second intent healing (SIH) in the periocular region is reserved for small and/or concave defects, particularly those located on the medial canthus. Aim The purpose of this study was to identify factors impacting outcomes of SIH for periocular tumors following Mohs micrographic surgery (MMS). Methods Retrospective analysis was performed of all periocular lesions treated with MMS followed by SIH from a single academic surgical center over a 5-year period. Data regarding tumor characteristics and follow-up was recorded. The modified Manchester scale was utilized to evaluate scar outcomes. Results Of the 39 tumors included, 14 (35.9%) were located on the lower eyelid, 12 (30.8%) on the upper eyelid, 6 (15.4%) on the lateral canthus, and 7 (17.9%) on the medial canthus. Involvement of the eyelid margin was seen in 11 (28.2%) of cases. The average defect diameter and area were 1.3 cm and 1.04 cm-squared. Twenty-three cases (59.0%) healed with optimal results. Larger defects were significantly associated with poorer outcomes of SIH (odds ratio 0.205, p = 0.017 by multivariate analysis). Anatomic location, involvement of the lid margin, age, and follow-up interval were not significant factors; however, medial canthus defects were least likely to heal with optimal results. On average, medial canthal lesions were larger in size (mean diameter 1.76 cm, mean area 1.97 cm-squared). Conclusions This retrospective study suggests that periorbital defects in all locations with area less than 1.04 cm2 heal well by SIH. In this cohort, larger lesions on the medial canthus healed with worse outcomes. Keywords Eyelid · Periorbital skin · Mohs surgery · Granulation · Second intent · Scar
Introduction Cutaneous malignancies involve periocular skin in 5–10% of cases [1]. Mohs micrographic surgery (MMS) is the preferred treatment modality for these lesions as tissue sparing is critical and subclinical spread of tumors is common [2]. Surgical defects in this region may pose a risk to eyelid function. Compromise of the free margin can result in cosmetic concerns and functional deficits such as xerosis, tearing, and foreign body sensation. Ectropion occurs when tension vectors of the repair or * Nour Kibbi [email protected] 1
Department of Dermatology, Stanford University, Palo Alto, CA, USA
Advanced Dermatology and Cosmetic Surgery, Phoenix, AZ, USA
2
healing process are perpendicular to the free margin. This can result from poor reconstructive design (in the case of a repair), formation of normal to hypertrophic scar tissue or compromise to the tarsus during the surgical procedure [3]. Second intent healing (SIH) for defects in the periorbital region has been discusse
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