Secondary Intention Healing
Secondary intention healing occurs in those wounds that are too ragged, wide or to be stitched. Secondary intention healing is also appropriate for ulcerations and puncture wounds. In secondary intention healing the wound must undergo debridement to remove necrotic tissues, foreign materials and pathogens before healing can occur. The process of debridement can be aided by the thorough cleansing of the wound site by a person. Once the wound is free of foreign or dead material healing occurs through granulation. This process occurs from the periphery towards the center of the wound, and from the bottom of the wound towards the surface. Secondary intention healing is a longer process than primary intention healing, and generally results in more scarring and granulation of the wound. With secondary intention healing, there is a greater chance of the formation of proud flesh in the lower limb.
Tertiary Intention Healing
Tertiary intention healing is in effect primary intention healing. In tertiary intention healing suturing is delayed for some reason, resulting in the formation of two layers of granulation tissue. Some examples of tertiary intention healing include infected wounds that are left open to clear the infection before suturing, or a sutured wound that was torn open by over- stretching of the tissues and then was re-sutured. Such cases often result in an increase in scar tissue as the separate layers of granulation tissue must not only heal, but they must heal together to form a cohesive unit.
Complications in Wound Healing
Many factors affect the speed and quality of healing. Poor nutrition, poor health or advanced age all delay wound healing as the body must use its limited resources for the maintenance of vital function instead of healing. Poor blood supply also delays the closure of a wound as fibroblasts and fibrin both travel to the site of injury through the blood vessels. Infection or contamination of a wound acts to delay healing as it prolongs the debridement process. Mechanical stress can act to delay wound healing as these forces may enlarge the wound or prevent the contracture of the scar as it matures. In some cases, a wound that has begun the healing process will be pulled apart by mechanical forces. occurs when a wound closed by scar tissue is pulled open by mechanical stretch.
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