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Primary Intention Healing and Other Types of Wound Closure

From stitches to staples, tapes to glues, we’re familiar with the many different types of wound closure. However, there are also three types of healing that physicians and surgeons can employ based upon the type of wound they are dealing with, whether it’s an abrasion, laceration, puncture, incision, or worse. Ultimately, it all comes down to taking into consideration how much skin and tissue has been lost.

Three Types of Healing Explained

Primary Intention Healing

Also known as “first intention healing” or “primary wound closure,” this type of healing is generally employed when there has been very little tissue loss and new blood vessels and keratinocytes need to migrate only a small distance. These clean wounds or surgical incisions are almost immediately closed with stitches, staples, glue such as Derma Bond, or tapes such as Steri Strips

In some instances, closure of the wound or incision may be delayed and require the skill of a plastic surgeon or orthopedic surgeon if the wound is jagged, asymmetrical, or could interfere with movement in a joint. There may also be a delay if the wound is significantly contaminated or too much time has passed (generally more than 4-8 hours). In these instances, surgeons may opt for second intention healing.

Secondary Intention Healing

Although most wounds and incisions are mended through primary intention healing, sometimes second intention healing (also known as “secondary closure healing”) is the chosen method. This occurs when there is a large tissue defect (possibly with infection), there has been extensive loss of cells and tissue, and wound edges cannot be approximated requiring new tissue to be formed to bridge the gap between wound edges or to “fill the wound.” 

As you may expect, second intention healing is a much slower process as it requires granulation tissue formation for the wound to contract, and can often result in a large, unpleasant scar. Surgical removal of dead tissue (debridement) can help.

Tertiary Intention Healing

Also known as “delayed” healing, tertiary intention healing occurs when a wound is initially left open in order to be “staged” for primary intention healing. The delay may be due to an unhealthy or unstable patient, infection or the presence of a foreign object, poor circulation to the injured area, a crush component, or if a significant amount of time has passed since the injury occurred. During staging, the wound is cleaned and damaged tissue is removed, and after a period of observation, primary wound closure may be performed if evidence of healing, viable tissue, and improved circulation becomes apparent as the body’s natural defenses take over. 

One injury often resulting in tertiary intention healing is wound dehiscence. This occurs when a wound previously closed through primary intention healing has come apart, often due to high tension over a joint, or in abdominopelvic surgeries, where dehiscence is estimated to occur in 0.5-3.4% of procedures. Unfortunately with tertiary intention healing, the repair time is longer, scarring is more pronounced, and the chances of infection are greater.

BandGrip for Wound Healing

Sutures, staples, glues, and adhesives all present unique challenges when it comes to primary intention healing. Today, surgeons have another option: BandGrip. The latest development in wound closure technology, BandGrip Micro-Anchor Skin Closures are a quick, intuitive, and non-invasive closure option for surgeons. Resembling a typical adhesive bandage, BandGrip’s patented micro-anchors grip the skin tightly and hold wound edges together to facilitate a secure closure offering many advantages:

  • Faster and easier application versus sutures and staples
  • Eliminates the risk of needlestick injuries
  • Can be applied by a nurse or physician’s assistant
  • Results in less scarring than sutures or staples
  • Supports better mobility due to its smooth, water-resistant surface
  • Ability to be tiled for larger wounds or incisions
  • Does not require a return visit for removal, saving surgeon’s time

Want to see BandGrip in action? View the video below.

Advanced Wound Closure