Lower Extremity Secondary Intention Wounds, Infection Risk, and the Role of WoundVax

Conclusions

• Lower-extremity secondary-intention wounds appear to have a generally low infection rate, although healing is often slow and influenced by dependent edema, venous insufficiency, and reduced perfusion.
• The literature on infection risk is mixed, but larger and more complex repairs often seem to carry higher infection rates than simpler closures, while secondary intention is not consistently worse than sutured wounds.
• Routine prophylactic antibiotics do not appear to meaningfully reduce infection rates for lower-extremity dermatologic surgery in the available studies.
• A practical postoperative regimen for these wounds may include hypochlorous acid cleansing, petrolatum, compression when tolerated, and ambulation.
• Hypochlorous acid seems well suited for wound care because it is broadly antimicrobial, anti-biofilm, and relatively non-cytotoxic compared with other antiseptics.
• Compression therapy alone has not shown consistent benefit for second-intention lower-extremity surgical wounds, especially in patients without clear chronic venous insufficiency.
• Exercise likely helps wound healing, probably by improving calf muscle pump function and circulation, and it may be a useful adjunct to compression.
• Negative pressure wound therapy can be helpful in selected high-risk wounds and may speed healing or improve graft outcomes, but its benefit for all lower-extremity secondary-intention wounds is not firmly established.
• The best candidates for negative pressure therapy may be patients with high-tension wounds, difficult anatomy, poor local healing conditions, or situations where faster closure is especially important.
• Overall outcomes may improve most when wound care is individualized and paired with medical optimization such as vascular assessment, glycemic control, smoking cessation, and nutritional support.