(2) Closure by secondary intent. Here the wound is allowed to granulate on
its own without surgical closure. The tissue is cleaned and dressed as usual, and the
wound is covered with a sterile dressing. This is the procedure of choice for closing
certain defects such as finger amputation and partial-thickness tissue loss. In the case
of finger amputations, this type of closure usually gives better cosmetic and functional
(3) Closure by tertiary intent. This is delayed primary closure. The wound is
initially cleaned and dressed as in secondary intent. The patient returns in three to four
days for definitive closure. This is the procedure of choice for contaminated lacerations
that would leave unacceptable scars if not closed. Examples of lacerations are
mammalian bites, contaminated crush-lacerations, and cases when the patient delayed
too long for treatment to close primarily.
b. Wound Debridement and Excision.
Debridement of adherent foreign material. Follow this procedure.
(a) Irrigate the wound. Carefully explore the wound for any foreign
Foreign material serves as a source of infection and may "tattoo" the skin if
the material is near the skin surface.
(b) Remove the foreign material. The simplest method is to abrade the
soiled region repeated with a 4 x 4 inch piece of gauze moistened with saline. An
alternate method is to excise the soiled tissue using forceps and an iris scissors or
(2) Trimming the wound edge. Trim minute irregularities from the wound
edges. This takes only a little time and often greatly improves the final appearance after
the wound has healed. Often, only one millimeter of tissue needs to be trimmed off.
Using sharp iris scissors, carefully trim off minor irregularities from the edge. A scalpel
can also be used.
(3) Excisions to improve wound configuration. Wounds with small circular
defects or with multiple small irregularities heal best if they are first converted to an
ellipse by excising the adjacent tissue. This small ellipse can be made before closure.
Such an adjustment decreased the chance of infection and improves the cosmetic
appearance. This type of incision should be performed by a physician or a physician's
assistant under the direct supervision of a physician. The incision should be planned so
that the final scar conforms to the patient's skin tension lines.