There are three basic methods by which a wound heals itself. Primary Intention is the usual type of healing when an incision or laceration is closed immediately to allow close adherence of the opposing skin edges and subcutaneous layers. This permits healing from side to side with the east amount of scarring and pain. The rate of healing of our skin depends on its blood supply and the presence or absence of pressure, tension, and infection. The facial skin, with its rich blood supply, can heal in 3-5 days, while a thickened area of skin with less nutritive potential, such as the back or feet, may require two weeks or more. If sutures are placed, it is important to know how long healing will require to avoid too early removal and wound separation.
Secondary healing of a wound occurs when the laceration is too large to be closed or is infected and must be left open. A general principle of laceration treatment is this. A wound that has been open more than 8-12 hours is never sutured, since infection may already have developed. In uch case, granulation occurs with the formation of a specialized tissue across the wound, and later coverage with new skin. Some deformity and scarring usually occurs. Nevertheless, with the exception of very large ulcers, the skin healing is usually complete. Understandably, this akes longer. Proper care of the wound to prevent or treat infection will serve to hasten the healing process.
The third method involves the initial formation of granulation tissue, then a secondary closure of the wound with sutures. This accelerates the healing in large open lesions and is usually used hen a surgical wound, for some reason, separates and must be closed again. Even more scarring takes place as a rule, but the healing is usually complete.
Some essential factors in wound healing are the presence of adequate protein, vitamins, oxygen, and the prevention of infection. It is generally recognized that the normal rate of healing in a perfectly healthy patient is the optimum rate that can be obtained. Wounds do not heal as well in anemic patients. With a normal complement of white blood cells the healing of a sterile wound is not impaired. However, when infection is present delayed healing does occur. Swelling (edema), whether local or general, appears to interfere with the healing process. Older individuals take onger to heal than the young. Endocrine factors, such as the possible deficiency of thyroid or growth hormone, or adrenal dysfunction, may retard or interfere with the healing process.
Local factors are important. According to Van’t Hoff’s law, reactions occur more rapidly when the temperature is increased. Conversely, hypothermia will delay wound healing in most areas, lthough cold is sometimes used for pain control. The areas of the skin which have the best blood supply, such as the face and neck, normally heal the fastest. Fat persons tend to heal more slowly, and their wounds tend to separate more often than in people of normal weight. Skin utures are usually left in longer. Cleanly incised wounds will heal more rapidly than irregular jagged lacerations. The presence of a blood clot or hematoma may interfere with proper wound healing by preventing close contact of the walls of the wound, and thus there forms a pocket, called “dead space.” Infected fluids, pus, and foreign bodies will all retard the healing of these wounds. It is critical to cleanse the wound of all foreign debris, irrigating it thoroughly before any suturing is attempted. Suture material is also important in the care of wounds. Although stainless steel is the least reactive, it is difficult to handle and remove. The absorption of foreign material, such as gut, silk, cotton, and nylon will occur slowly, in the order that they are here
mentioned. Newer sutures of nylon, Dacron, and Teflon last longer and cause less reaction, but are not suitable everywhere. A suture use manual may be consulted to aid in selecting ppropriate materials. The suture manufacturer’s suggestion of needle size, type, and techniques should also be consulted.
Secondary healing of a wound occurs when the laceration is too large to be closed or is infected and must be left open. A general principle of laceration treatment is this. A wound that has been open more than 8-12 hours is never sutured, since infection may already have developed. In uch case, granulation occurs with the formation of a specialized tissue across the wound, and later coverage with new skin. Some deformity and scarring usually occurs. Nevertheless, with the exception of very large ulcers, the skin healing is usually complete. Understandably, this akes longer. Proper care of the wound to prevent or treat infection will serve to hasten the healing process.
The third method involves the initial formation of granulation tissue, then a secondary closure of the wound with sutures. This accelerates the healing in large open lesions and is usually used hen a surgical wound, for some reason, separates and must be closed again. Even more scarring takes place as a rule, but the healing is usually complete.
Some essential factors in wound healing are the presence of adequate protein, vitamins, oxygen, and the prevention of infection. It is generally recognized that the normal rate of healing in a perfectly healthy patient is the optimum rate that can be obtained. Wounds do not heal as well in anemic patients. With a normal complement of white blood cells the healing of a sterile wound is not impaired. However, when infection is present delayed healing does occur. Swelling (edema), whether local or general, appears to interfere with the healing process. Older individuals take onger to heal than the young. Endocrine factors, such as the possible deficiency of thyroid or growth hormone, or adrenal dysfunction, may retard or interfere with the healing process.
Local factors are important. According to Van’t Hoff’s law, reactions occur more rapidly when the temperature is increased. Conversely, hypothermia will delay wound healing in most areas, lthough cold is sometimes used for pain control. The areas of the skin which have the best blood supply, such as the face and neck, normally heal the fastest. Fat persons tend to heal more slowly, and their wounds tend to separate more often than in people of normal weight. Skin utures are usually left in longer. Cleanly incised wounds will heal more rapidly than irregular jagged lacerations. The presence of a blood clot or hematoma may interfere with proper wound healing by preventing close contact of the walls of the wound, and thus there forms a pocket, called “dead space.” Infected fluids, pus, and foreign bodies will all retard the healing of these wounds. It is critical to cleanse the wound of all foreign debris, irrigating it thoroughly before any suturing is attempted. Suture material is also important in the care of wounds. Although stainless steel is the least reactive, it is difficult to handle and remove. The absorption of foreign material, such as gut, silk, cotton, and nylon will occur slowly, in the order that they are here
mentioned. Newer sutures of nylon, Dacron, and Teflon last longer and cause less reaction, but are not suitable everywhere. A suture use manual may be consulted to aid in selecting ppropriate materials. The suture manufacturer’s suggestion of needle size, type, and techniques should also be consulted.
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