From the Guidelines
Wound healing by first intention is the preferred method when possible due to faster healing times and better cosmetic outcomes, but second intention healing is necessary for wounds with tissue defects or contamination. Wound healing by first intention and second intention are two distinct processes that occur based on the nature and management of a wound. First intention healing occurs when wound edges are closely approximated, such as in surgical incisions or clean cuts that are sutured together. The wound closes quickly with minimal scarring because there is little tissue loss, and the healing process involves direct formation of new tissue between the closely aligned edges. Examples include surgical incisions, paper cuts, or small lacerations that are promptly sutured. In contrast, second intention healing occurs when wounds have significant tissue loss or when edges cannot be approximated, requiring the wound to fill in from the bottom up with granulation tissue. This process takes longer, produces more scarring, and involves more pronounced inflammatory responses. Examples include pressure ulcers, large burns, infected wounds that must be left open, or wounds with extensive tissue loss.
The choice between these healing methods depends on wound characteristics, location, infection risk, and tissue viability. According to the most recent guidelines, sharp debridement is recommended for wound healing, especially in diabetic foot ulcers, as it promotes a clean environment for healing 1. The use of dressings should be based on exudate control, comfort, and cost, and antimicrobial dressings should not be used with the goal of improving wound healing or preventing secondary infection 1.
Some key differences between first and second intention healing include:
- Healing time: First intention healing is generally faster than second intention healing
- Scarring: First intention healing typically results in less scarring than second intention healing
- Inflammatory response: Second intention healing involves a more pronounced inflammatory response than first intention healing
- Tissue loss: Second intention healing is often necessary for wounds with significant tissue loss or contamination.
In clinical practice, the decision to allow a wound to heal by first or second intention should be based on the individual patient's needs and the specific characteristics of the wound. The primary goal should always be to promote optimal wound healing and minimize the risk of complications, while also considering the patient's quality of life and potential morbidity and mortality associated with the wound.
From the Research
Wound Healing by First and Second Intention
Wound healing can occur through two main processes: first intention and second intention.
- Wound healing by first intention occurs when the edges of a wound are closely approximated, allowing for direct healing with minimal scar tissue formation 2.
- Wound healing by second intention occurs when the edges of a wound are not closely approximated, resulting in the formation of granulation tissue and eventual closure of the wound with scar tissue formation.
Comparison of Wound Healing by First and Second Intention
The main differences between wound healing by first and second intention are:
- The amount of scar tissue formed: wound healing by first intention results in minimal scar tissue formation, while wound healing by second intention results in significant scar tissue formation.
- The time required for healing: wound healing by first intention is generally faster than wound healing by second intention.
- The risk of infection: wound healing by second intention is associated with a higher risk of infection due to the presence of exposed tissue.
Clinical Examples
Clinical examples of wound healing by first intention include:
- Surgical incisions that are closed with sutures or staples.
- Lacerations that are closed with sutures or staples. Clinical examples of wound healing by second intention include:
- Large wounds that cannot be closed with sutures or staples.
- Chronic wounds, such as diabetic foot ulcers or venous leg ulcers, that are treated with dressings and topical therapies 3, 4.
- Burns that are treated with dressings and topical therapies 5, 6.
Treatment Options
Treatment options for wound healing by first and second intention include:
- Dressings: various types of dressings, such as silver-impregnated dressings, can be used to promote wound healing and prevent infection 2, 3, 6.
- Topical therapies: topical therapies, such as antibiotics and growth factors, can be used to promote wound healing and prevent infection 5, 4.
- Surgical interventions: surgical interventions, such as debridement and skin grafting, may be necessary to promote wound healing in some cases.