By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

When we are caught up in complex treatment protocols or surrounded by paperwork, it is sometimes easy to forget that the one thing that really matters in wound management is achieving wound closure. When a wound has closed properly, our work is done. Given the fundamental nature of wound closure, it is worth spending a few moments recapping what we know about the subject.

Wound closure happens in one of three ways. Primary wound closure is the fastest type of closure, and is also known as healing by primary intention. Wounds that heal by primary closure have a small, clean defect that minimizes the risk of infection and requires new blood vessels and keratinocytes to migrate only a small distance. Surgical incisions, paper cuts, and small cutaneous wounds usually heal by primary closure. These wounds do not usually trouble the wound care specialist.

Secondary wound closure, also known as healing by secondary intention, describes the healing of a wound in which the wound edges cannot be approximated. Secondary closure requires a granulation tissue matrix to be built to fill the wound defect. This type of closure requires more time and energy than primary wound closure, and creates more scar tissue. The majority of wounds close by secondary wound closure.

Occasionally, wounds are closed by delayed primary closure, also known as healing by tertiary intention. Delayed primary closure is a combination of healing by primary and secondary intention, and is usually instigated by the wound care specialist to reduce the risk of infection. In delayed primary closure, the wound is first cleaned and observed for a few days to ensure no infection is apparent before it is surgically closed. Examples of wounds that are closed in this way include traumatic injuries such as dog bites or lacerations involving foreign bodies.

References
Myers BA. Wound management principles and practice. 2nd ed. Upper Saddle River, NJ: Pearson; 2008.

About The Author

Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.