From the Guidelines
Primary intention healing is generally preferred over secondary intention healing due to its faster healing time and minimal scarring, but the choice between the two ultimately depends on the wound characteristics, location, and presence of infection, as evidenced by studies such as 1 and 1. When considering the healing process, primary intention healing occurs when the edges of a clean wound are brought together and secured, typically with sutures, staples, or adhesive strips. This method is used for surgical incisions or clean cuts where the wound edges can be approximated closely. The wound heals quickly with minimal scarring because there is little tissue loss and the edges are in direct contact. Some key points to consider when deciding between primary and secondary intention healing include:
- Wound characteristics: The size, depth, and location of the wound can influence the choice between primary and secondary intention healing.
- Presence of infection: Infected wounds may require secondary intention healing to allow for proper drainage and debridement.
- Tissue loss: Wounds with significant tissue loss may require secondary intention healing to fill the defect. As noted in 1, the width of the excision and not the wound closure technique influenced the therapeutic outcome, whereas vacuum-assisted closure may accelerate the time-point of a delayed primary closure. In contrast, secondary intention healing occurs when wounds have tissue loss, infection, or cannot be closed directly. The wound is left open and gradually fills with granulation tissue from the bottom up and edges inward. This process takes longer than primary healing and typically results in more noticeable scarring. Examples of secondary intention healing include pressure ulcers, large abrasions, or infected wounds, as discussed in 1, which highlights the use of different approaches to wound closure following excision of cutaneous squamous cell carcinomas in patients with epidermolysis bullosa. The most recent and highest quality study, 1, suggests that primary intention healing may be associated with better outcomes in terms of recurrence rates, with a study showing 69.9% recurrences after primary closure and no recurrences in the 'graft' and 'flap' series. However, the choice between primary and secondary intention healing should be guided by anatomical considerations and the availability of suitable donor skin, as well as the presence of infection or tissue loss. Ultimately, the goal of wound management is to achieve optimal functional and cosmetic outcomes, and the choice between primary and secondary intention healing should be made on a case-by-case basis, taking into account the individual patient's needs and wound characteristics, as supported by studies such as 1 and 1.
From the Research
Primary vs Secondary Intention Healing
- Primary intention healing refers to the process of wound closure where the edges of the wound are brought together with sutures, staples, adhesive glue, or clips, allowing the wound to heal quickly with minimal scarring 2.
- Secondary intention healing, on the other hand, occurs when a wound is left open to heal from the "bottom up", often due to a high risk of infection or significant tissue loss 2, 3.
- Studies have shown that negative pressure wound therapy (NPWT) can be an effective treatment option for surgical wounds healing by secondary intention, with some evidence suggesting improved wound closure rates and reduced hospital stay 2, 4.
- However, the quality of evidence for NPWT in secondary intention healing is generally low, and further research is needed to fully understand its benefits and harms 4.
- Patients with surgical wounds healing by secondary intention often experience significant physical and psychosocial challenges, including pain, frustration, and feelings of powerlessness, highlighting the need for effective and compassionate care 3.
- In contrast, primary intention healing can be achieved in many cases, even for open fractures, with some studies suggesting that immediate primary closure can be a safe and efficient practice with low rates of infection and complications 5.