Types of Wound Closure

Wound closure is accomplished one of three ways: by primary intention, secondary intention, or tertiary intention, also known as delayed primary closure. Let's explore these various types of wound healing by clicking on the tabs. The simplest and fastest type of wound closure is referred to as healing by primary intention. Primary intention involves reepithelialization, in which the skin's outer layer grows closed. Cells grow in from the margins of the wound and out from epithelial cells lining the hair follicles and sweat glands. Wounds such as abrasions that involve only the epidermis heal by primary intention. In addition, deeper wounds such as surgical wounds with well-approximated edges heal by primary intention. In these types of wounds, the edges are brought together using sutures or adhesive strips. Wounds that close by primary intention are associated with minimal tissue loss. Secondary intention occurs when there is a greater degree of tissue loss or with surgical wounds whose edges cannot be easily brought back together. Wounds that heal by secondary intention have a higher risk of infection, longer healing times, and result in visible scarring. A dehisced surgical wound is an example of a wound that heals by secondary intention. Occasionally, wounds are closed by delayed primary intention. This is a combination of healing by primary and secondary closure, also called healing by tertiary intention. If a wound is contaminated, this technique may be used to decrease the risk of infection. The wound is initially cleansed and observed for several days. Once the wound appears clean, it is surgically closed. In general, delayed surgical closure is used on surgical wounds or lacerations once they are believed to be free of contamination.