Wounds and healing 6, Primary and secondary healing

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Healing by primary intention
A wound will heal by primary intention if the edges of the wound can be approximated together. Some form of wound closure is normally employed to keep the wound edges closed. Common ways of achieving closure and stability of the wound edges include adhesive strips, sutures or super glue.
Advantages of healing by primary intention
Approximation and stabilisation will allow the edges of a wound to heal directly into each other. In primary healing the process is fairly rapid, normally wound edges will be closed with sufficient tensile strength to remove the sutures after 7-10 days. However, it takes much longer than this to restore full strength to the wound, even after 2 weeks the wound only has 20% of full strength. If the edges of a wound are closed, the surface area of the wound is reduced. This means that there will be a minimal amount of scar tissue formed, giving good cosmetic and functional results. As the wound is closed, there is less opportunity for secondary colonisation or infection to enter the wound from outside sources of microbiological contamination.
Potential problems with primary intention
Because the wound edges are closed, there is the possibility that foreign material or bacteria may be enclosed within the wound. This will allow any bacteria present to multiply and lead to wound infection with possible abscess formation. Also the presence of foreign material can lead to future complications such as pain and damage to tissues. If foreign material can be removed before closure, this particular complication may be prevented; this is one reason why wound exploration is so vital. If the wound is likely to be contaminated with bacteria from the implement which made the wound, then again it is unwise to close the wound, unless the practitioner feels they are able to adequately wash away the contamination with irrigation or other wound cleaning procedures. When primary healing is not possible, or is not advisable, healing by secondary intention will be used.
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