A prospective case series of secondary intention healing for surgical wounds on the dorsum of the hand

Abstract

The dorsum of the hand is a common site for squamous cell carcinoma, and excision with appropriate margins often results in surgical defects that cannot be repaired by primary side-to-side closure. To assess healing time, complications and resulting scars when surgical wounds on the dorsum of the hand were allowed to heal by secondary intention. This was a prospective study of 28 surgical defects on the dorsum of the hand, which were allowed to heal by secondary intention. Patients were followed up on days 2, 7 and 14, and then every 2 weeks until the wounds healed. Wound dressings were changed 2-3 times per week. Patients' tolerance of this treatment and their degree of satisfaction with the final results was determined. The defect diameters ranged from 15 to 46 mm (median 24 mm). The time to heal was determined in 24 patients, and ranged from 22 to 63 days (median 44 days). There were no cases of postoperative bleeding. Two patients developed erythema of the wound edge; wound swabs for culture were negative in both cases. Overgranulation developed in 12 of 28 wounds, which settled with the application of a potent topical steroid and discontinuation of the hydrocolloid dressing. Patients were either 'very satisfied' (12/18) or 'satisfied' (6/18) with the resulting scar. Secondary intention healing of surgical wounds on the dorsum of the hand is a useful management option, which is well tolerated by patients, has a low rate of complications, and gives good cosmetic results.