Types of Wound Healing

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Types of Wound Healing There are three types of wound healings that are identified. They are listed as first intention (primary union), second intention (granulation), and third intention (delayed primary closure). The type of wound healing is based upon the type and condition of the tissue. First intention healing occurs with a primary union that is typical of an incision opened under ideal conditions. The first phase of wound healing by first intention is the Lag phase or Inflammatory Response Phase. This stage begins within minutes of injury and lasts approximately 3-5 days. It is defined by the physiological changes associated with inflammation manifested as heat, redness, swelling, pain, and loss of function. Phase 2 is the Proliferation Phase. This stage begins on approximately the third postoperative day and continues for up to 20 days. Fibroblasts multiply and bridge the wound edges. Phase 3 is the Maturation or Differentiation Phase. This stage begins on the 14th postoperative day and lasts until the wound is completely healed (up to 12 months). Second intention healing occurs when a wound fails to heal by primary union. It generally occurs in large wounds that cannot be directly approximated or in which infection has caused breakdown of a sutured wound. Third intention wound healing, or delayed primary closure, occurs when two granulated surfaces are approximated. The traumatic (Class III or IV) surgical wound is debrided and purposely left open to heal by second intention (granulation) for approximately 4 to 6 days. Three main factors influence the rate at which wound healing occurs, the strength of the healed wound, and the risk of infection. The first consideration is the physical condition of the patient, which includes age, nutritional status, disease, smoking, radiation exposure, and immunocompromised or immunosuppressed

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