DS24 Secondary intention healing should be offered for shallow lower-lip defects involving the vermilion border following Mohs micrographic surgery

Abstract Reconstruction of lip defects is challenging due to the need to preserve both oral function and aesthetic integrity. Compared with the upper lip, the lower lip is anatomically simpler and is considered a single subunit. Traditionally, lip reconstruction techniques are selected based on the horizontal extent of the lip defect; primary closure is typically used for defects less than one-third of the total lip width, while larger defects measuring one-third to two-thirds of lip width often require local flap techniques. We present three cases of lower-lip defects following Mohs micrographic surgery (MMS) that were managed with secondary intention healing, demonstrating favourable functional and cosmetic outcomes. The first case involved a 75-year-old man with a squamous cell carcinoma (SCC) involving the vermilion border of the left lower lip. The second case was in an 81-year-old woman with an SCC invading muscle affecting the vermilion border of the left lower lip. The third case involved a 74-year-old man who presented with an SCC on the vermilion border of the left lower lip. All tumours were removed after a single stage of MMS, resulting in defects extending to muscle, measuring 28 × 17 mm, 30 × 12 mm and 20 × 15 mm, respectively. Two of the three patients received preoperative antibiotics, with one patient continuing them postoperatively. Wound care included application of mupirocin or yellow soft paraffin, followed by an initial pressure dressing consisting of a nonadhesive layer, gauze and self-adhesive tape, which was removed after 48 h. Hydrocolloid dressings were then applied and changed three times weekly until full granulation and re-epithelialization were achieved. Patients were followed up via telephone at 2 weeks, with in-person wound reviews at 3–6 weeks, and a clinic review at 3 months. No postoperative complications were observed. All wounds healed completely within 6 weeks of surgery. Postoperative Mohs questionnaires indicated high patient satisfaction, with no reported functional impairment. The cosmetic outcome was considered good in all three cases. Secondary intention healing is a viable reconstructive option for selected lower-lip defects following MMS. It offers a balance between minimizing the morbidity associated with complex repairs and achieving acceptable cosmetic and functional outcomes. Appropriate patient selection, shared decision making and meticulous wound care are essential for achieving favourable outcomes.