Secondary Intention Healing for Facial Skin and Soft Tissue Defects: Case Report and Review of Literature.

BACKGROUND

Various surgical techniques are available for facial skin and soft tissue defect repair, with flap reconstruction being the current mainstream choice. Secondary intention healing (SIH) has re-emerged as a viable option with unique advantages, yet its standardized clinical application criteria and up-to-date evidence base remain to be systematically summarized.

METHODS

We performed a systematic literature review of studies on SIH for facial defect repair, with predefined search strategies, inclusion and exclusion criteria across PubMed, Embase, Cochrane Library, and Web of Science from database inception to December 2025. Concurrently, we presented a case series of 3 patients who underwent SIH for facial tumor resection defects at our institution, with detailed clinical data and long-term follow-up outcomes.

RESULTS

A total of 37 eligible clinical studies were included in the final review. The evidence confirmed that SIH achieves excellent cosmetic and functional outcomes in concave facial subunits (NEET areas), with satisfactory results in FAIR areas for appropriately sized defects. The procedure offers the advantages of no auxiliary incisions, simple operation, low cost, and the ability to monitor tumor recurrence in strictly selected cases. Our case series further validated the favorable outcomes of SIH in nasal sidewall, periocular, and cheek defects, with complete re-epithelialization within 7-10 days and no severe complications during follow-up.

CONCLUSION

For properly selected small-to-medium facial skin and soft tissue defects, SIH is a straightforward, safe, well-tolerated, and cost-effective repair modality. This review and case series provide updated evidence and clinical decision-making references for the application of SIH in facial defect reconstruction.

LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .