(a) Primary closure is the term for a wound that is repaired immediately
after the injury. Use sutures, skin tapes, staples, or tissue adhesives such as steri-
strips and butterflies to cover the wound. For example, a child falls down and skins his
knee. The wound is cleansed, and a bandage applied over it. This is primary closure.
Wounds treated in this manner heal fastest and with the best cosmetic results; that is,
little or no scarring. Primary closure is the treatment of choice for any wound that is not
infected or grossly contaminated. Most lacerations closed in this manner must be done
within eight hours from the time of the injury.
(b) Secondary closure is the term for wounds which are allowed to
granulate on their own without surgical closure. Clean and prep the wound in the usual
manner. Then, cover the wound with a sterile dressing. Secondary closure is used for
certain kinds of wounds such as fingertip amputations or partial thickness tissue loss.
(c) Tertiary intent closure is the process of cleaning and dressing a
wound initially, but not closing the wound. The patient returns for definite closure in
three to four days. Tertiary intent closure is also called delayed primary closure. This is
the method of choice for repairing contaminated lacerations that would leave
unacceptable scars if not closed. This method can also be used for patients who did
not seek immediate care for their lacerations.
The body's skin tension lines are important in wound closure. Pinch your skin
together, and you can see lines or creases that naturally occur in the skin.
The configuration of creases is different in various parts of the body. A
laceration that follows the lines will heal with less scarring than a laceration
that runs across the lines. Other names for these lines are cleavage lines
and Lines of Langer.
e. Impaled Foreign Object. An impaled object in a puncture wound requires
careful treatment. A knife, a steel rod, a glass shard, or any number of other objects
can be impaled. General treatment rules are given below.
(1) DO NOT remove the impaled object. Removing it may cause severe
bleeding because the object was exerting pressure on severed blood vessels.
Removing the object could also cause further injury to muscles, nerves, and other soft
(2) Carefully expose the wound area. That is, cut clothing away so that you
can see the wound site. Be very careful not to disturb the impaled object as you do this.
DO NOT lift clothing over the impaled object. If the impaled object is long, stabilize it by
hand when you are trying to expose the wound, control bleeding, and dress the wound.