SpotCheck Clinical Staff
When Mohs surgery is done on the lower leg—especially the shin—many patients are surprised when their dermatologist recommends letting the wound heal on its own instead of closing it with stitches. This process, called secondary intention healing, can sound unusual, but for wounds on the shin, it's often the approach that leads to safer healing and better long-term results.
Here's why this method is commonly recommended and why it may actually be the best choice for you.
The skin on the front of the lower leg is thin, tight, and doesn't stretch easily. There's also less blood flow compared to areas like the face or scalp. Because of this, pulling the skin together to close a Mohs wound often creates a lot of tension. High tension can make the area painful, increase swelling, and make the stitches more likely to break open. It also reduces blood supply to the edges of the skin, which slows healing and raises the risk of infection.
Allowing the wound to heal naturally gives the skin space to repair itself at a comfortable pace. Without tight stitches, the area maintains better blood flow, and that helps new tissue grow in cleanly and predictably. Patients typically have fewer issues with wound reopening, breakdown, or tissue loss. Interestingly, infection rates can be lower with natural healing on the shin because the skin isn't being forced together under tension.
Many people find that open healing actually results in less discomfort. There's no pulling sensation from stitches and less swelling around the wound. Because the shin stretches every time you walk, bend, or take the stairs, stitches in that area can feel tight or painful. Natural healing tends to move with you more easily, which makes daily activities less irritating.
Patients often assume that a wound left open will scar more noticeably. On the shin, the opposite is often true. Sutured wounds in this area can heal wide, raised, or unevenly because of the tension placed on them. A naturally healing wound fills in from the bottom up and gradually contracts, often leading to a smoother, flatter, and softer scar once fully healed. Over time, many scars from secondary intention healing blend in very well with the surrounding skin.
When a Mohs wound on the shin is large, closing it with stitches may not be possible without creating excessive tension. In those cases, the alternatives are usually a skin graft or a flap procedure. These can be excellent options when needed, but they involve longer surgery times, more restrictions, higher cost, and often a second wound where skin is taken. Natural healing avoids this added complexity for many patients and still leads to excellent outcomes.
Stitched wounds on the lower leg come with strict rules: no heavy exercise, limited walking, no bending that stretches the area, and careful elevation to reduce swelling. These restrictions can last weeks. With natural healing, patients generally have more flexibility because there's no suture line that can tear or split open. Many people find the overall recovery easier to manage.
Healing this way takes patience. Most shin wounds take several weeks to fill in and a few months to fully settle, depending on the size of the surgery. You will need to keep the area clean, moist, and covered according to your dermatologist's instructions. The wound will gradually develop healthy new tissue and shrink over time. Although the process can look slow, the end result is typically strong, stable skin.
Not every wound or patient is a candidate for secondary intention healing. Very deep wounds, wounds that expose structures that need protection, or patients who can't perform the necessary wound care may benefit from a stitched closure or graft instead. Your dermatologist will guide you based on the size, depth, and location of your specific Mohs wound.
Even though it may feel counterintuitive, letting a Mohs wound on the shin heal naturally is often safer, more comfortable, and ultimately more cosmetically pleasing than closing it with stitches. The unique characteristics of the lower leg make open healing a reliable and predictable option for many patients. With proper wound care and time, this method can lead to excellent long-term results—often better than what can be achieved with sutures in this challenging area.