Secondary intention healing (SIH) is an underappreciated yet valuable method for repairing facial skin and soft tissue defects, particularly for general surgeons practicing in trauma, rural, or community settings. This review reframes SIH from a general surgical perspective, focusing on clinical decision-making—including core principles, indications, contraindications, technical essentials, and referral criteria. We integrate evidence from recent years to highlight when SIH can safely yield acceptable functional and cosmetic outcomes, and when referral for advanced reconstruction is necessary. For small, concave facial defects (eg, medial canthus and nasal ala) in patients with good wound healing capacity, SIH offers simplicity, cost-effectiveness, and minimal scarring; however, it is inappropriate for convex/tension-bearing regions (eg, nasal tip and lip margin) or large/deep defects. This practical framework equips general surgeons to incorporate SIH into routine practice for facial soft-tissue injuries and oncologic defects.
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