(1) Primary intention is the ideal method of wound healing. The wound is a
clean, straight line with little loss of tissue. All wound edges are well approximated and
sutured closed. It is a form of connective tissue repair that involves proliferation of
fibroblasts and capillary buds and the subsequent development of collagen to produce a
scar. Most surgical incisions and small sutured lacerations heal by primary intention.
These wounds normally heal rapidly with minimal scarring.
(2) Secondary intention is healing of an open wound where there has been
a significant loss of tissue. The edges may be so far apart that they cannot be pulled
together satisfactorily. Infection may also cause a separation of tissue surfaces and
prevent wound approximation. The wound is usually not sutured closed. Granulation
tissue is allowed to form, followed by a large scar formation. Epithelium ultimately grows
over the scar tissue.
(3) Tertiary intention is delayed primary closure. The wound is left open for
several days and is then sutured closed. There is increased risk of infection and
inflammatory reaction. The wound is usually one that is fairly deep and likely to contain
accumulating fluid. A drain or pack gauze may be placed into the wound to provide for
b. The greater the tissue damage, the greater the demand on the body's
reparative processes. The ability to close an open wound affects the rate of healing and
prevention of complications.
8-21. FACTORS WHICH MAY IMPAIR WOUND HEALING
a. Developmental Stage. Children and adults in good health heal more rapidly
than do elderly persons who have undergone physiologic changes that result in diminished
fibroblastic activity and diminished circulation. Older adults are more likely to have chronic
illnesses that cause pathologic changes that may impair wound healing.
b. Poor Circulation and Oxygenation. Blood supply to the affected area may be
diminished in elderly persons and in those with peripheral vascular disorders,
cardiovascular disorders, hypertension, or diabetes mellitus. Oxygenation of tissues is
decreased in persons who smoke, and in those with anemia or respiratory disorders.
Obesity slows wound healing because of the presence of large amounts of fat, which has
fewer blood vessels.
c. Physical and Emotional Wellness. Chronic physical illness and severe
emotional stress have a negative affect on wound healing. Patients who have inadequate
nutrition, those who are taking steroid drugs, and those who are receiving postoperative
radiation therapy have a higher risk of wound complications and impaired wound healing.
d. Condition of the Wound. The specific condition of the wound affects the
healing process. Wounds that are infected or contain foreign bodies (including drains,
pack gauze) heal slowly.