Surgical Technology Chapter 11

Wound Classification I

Pain heat redness swelling loss of function

First intention healing occurs with a primary union that is typical of an incision opened under ideal condition. Healing occurs from side to side in a sterile wound in which dead space has been eliminated and the wound edges have been accurately approximated. wounds heal repaidly with no separation of the edges and minimal scarring. wounds tensile strength plateaus at the thierd mounth at 70-80% of orginal strenght.Healing by first intention occurs in three distinct phases

Third intention healing , or delayed primary closure, occurs when two granulated surfaces are approximated.The traumatic (class 3 or class 4 ) surgical wound is debrided and purposely left open to heal by second intention (granulation) for approximately 4 to 6 days. The patient may be treated with systemic antibiotics and special wound care techniques may be used to treat or prevent infection . The infection-free wound is then closed and allowed to finish the healing process through first intention (primary closure ). The result is a wound that heals by contraction,granulation, and connective tissue repair,with intermediate tensile strenth and scarring .This method of repair works well for contaminated or dirty wounds that result from trauma and tissue loss

Second intention healing occurs when a wound fails to heal by primary union. It generally occurs in a large wounds that cannot be directly approximated or in which infection has caused breakdown of sutured wound. It also occurs in a wound in which the risk of infection is so great that the primary wound closure would result in infection. Second intention healing may be allowed following the removal of necrotic tissue or after a wide debridement.The wound left open and allowed to heal from the iner layer to the outside surface.