Chapter 21: Table of Contents
All wound factors should be evaluated to determine the most appropriate method for wound management / closure.
- Primary Closure: closing a wound that has just occurred by suturing the fresh wound margins in apposition. Ideally reserved for wounds that are less than 6 hours, are minimally contaminated and have little soft tissue injury.
- Delayed Primary Closure: surgical closure of the wound 3 to 5 days following injury and before granulation tissue has formed. This is typically used for wounds that are slightly older or have contamination and cannot undergo primary closure. Wounds are treated open for a few days with regular lavage, debridement (i.e. sugar, honey, wet-to-dry) and bandage changes to clean them in preparation for closure.
- Secondary Closure (Tertiary closure): surgical closure of the wound once granulation tissue is present (typically 5 days or more after wound has occurred). Allows for prolonged open management of wounds for debridement and treatment of infection.
If a wound is contaminated or dirty, primary closure should not be performed. It is best to perform daily bandaging until debridement is complete, then reassess and close if indicated.
- Second intention healing: when a wound is left to heal and close on its own by epithelialization and contraction. Ideal for wounds that are heavily contaminated or bruised in an area with loose enough skin for contraction to occur. This is a common method used successfully for shearing wounds of the distal extremities despite the lack of available loose skin.