Purpose:
The reconstruction planning for nonmelanoma skin cancer is well established and descriptive. Routine practices for superficial skin defects larger than 1cm2 without bone or vital organs exposure are skin grafting or local flaps for primary wound reconstruction. However, for the old and diseased, poor physical condition contributes to high perioperative risk which hinders patients from receiving prolonged reconstruction surgeries or procedures performed under general anesthesia. This study statistically analyzes the safety and the final cosmetic result of skin defects by means of skin cancer wide excision under local anesthesia left to heal by secondary intention in the asian elderly patients.

Materials and Methods:
A chart review of post tumor excision reconstructions using secondary intention healing between 2016 and 2022 (n=15) was undertaken. All reconstructions were performed in one center, and the wound defects were the result of tumor excision by means of wide excision under local anesthesia. No other reconstruction method was used. Perioperative risks of all patients were categorized in The American Society of Anesthesiologists physical status classification. For analysis of cosmetic outcome, the most recent photographs of the scars were assessed by five independent surgeons using a categorical judgment scale(non-healing, poor, fair, good and excellent).

Results:
There were a total of 13 patients with 15 wounds. These patients underwent secondary intention healing after non-melanoma skin cancer excision presented with age ranging from 69 to 100 years old, with mean age of 87.7 years old. The location of the skin defects included 8 in the face and ear region, 2 in the scalp and 5 in the limbs. The wound size ranges from 0.99cm2 to 16cm2, with a mean area of 6.8cm2. The American Society of Anesthesiologists (ASA) physical status classification score of the patients ranges from 2 to 4. The mean ASA score was 3.4. Of 15 wounds, 11 provided photographs of the scars were assessed by five independent surgeons. 73 percent of the wounds(8 of 11) healed with an “excellent” outcome. 18 percent of the wounds(2 of 11) healed with a “good” outcome. 9 percent of the wounds(1 of 11) healed with “poor” outcome, related to local recurrence of squamous cell carcinoma.

Conclusions:
This study presents statistical evidence that superficial wounds that are left to heal by secondary intention have a high chance of healing with an excellent cosmetic outcome in elderly patients. Although taking a step down the reconstruction ladder for the elderly patients leaves a wound that takes time to heal. Still, it is a safe and effective method with excellent outcomes.

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