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Wounds that cannot be closed primarily due to substantial tissue loss can be healed by secondary intention, a process in which the wound is allowed to fill-in over time through natural physiologic processes. When healing by secondary intention, granulation tissue grows in from the wound edges slowly over time to restore integrity of the skin.
The wound is purposely left open. Examples: healing of wounds by use of tissue grafts. If the wound edges are not reapproximated immediately, delayed primary wound healing transpires. This type of healing may be desired in the case of contaminated wounds.
Jenkin's rule was the first research result in this area, showing that the then-typical use of a suture-length to wound-length ratio of 2:1 increased the risk of a burst wound, and suggesting a SL:WL ratio of 4:1 or more in abdominal wounds. [19] [20] A later study suggested 6:1 as the optimal ratio in abdominal closure. [21]
Wounds are normally described in a variety of ways. Descriptions may include wound size (length) and thickness; plainly visible wound characteristics such as shape and open or closed; and origin, acute or chronic. [3] The most common descriptors of wounds are these: Incision: Straight edges
Marsupialization is the surgical technique of cutting a slit into an abscess or cyst and suturing the edges of the slit to form a continuous surface from the exterior surface to the interior surface of the cyst or abscess. Sutured in this fashion, the site remains open and can drain freely.
The periwound (also peri-wound) is tissue surrounding a wound. Periwound area is traditionally limited to 4 cm outside the wound's edge but can extend beyond this limit if outward damage to the skin is present. Periwound assessment is an important step of wound assessment before wound treatment is prescribed. [1]
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The wound can be allowed to close by secondary intention. Alternatively, if the infection is cleared and healthy granulation tissue is evident at the base of the wound, the edges of the incision may be reapproximated, such as by using butterfly stitches , staples or sutures .
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