What Are the Categories of Wound Closure?

An open wound can be closed in any of the three ways.
An open wound can be closed in any of the three ways.

An open wound can be closed in any of the three ways. These ways are referred to as the three categories of wound closure or three ways of wound healing. These are as follows:

  • Wound closure by primary intention: Also known as immediate closure, this refers to wound closure in which the wound edges are brought together and held together by sutures (stitches). Closure by primary intention becomes necessary to prevent the wound from getting gaped or infected. This allows for faster healing of the wounds. Suturing needs to be done immediately for simple wounds of the face where delayed healing can result in scarring.
  • Wound closure by secondary intention: This refers to allowing the wound to heal by leaving it exposed. The strategy is usually adopted for chronic wounds, in amputations of the finger, and in wounds in which a thick layer of the skin is lost. Healing by secondary intention takes a longer time due to the huge thickness of the lost skin/tissue.
  • Wound closure by tertiary intention: Also known as delayed primary closure, this refers to leaving the wound open for some period before suturing it. Till then, only cleansing and dressing of the wounds are carried out. This is also referred to as delayed primary closure. The wounds for which healing by delayed primary closure is required are usually grossly contaminated but do not have significant tissue loss. They can be closed after the wound is thoroughly explored, washed off, debrided, and monitored for three to seven days before suturing it or using a skin graft to close it. This strategy is also adopted in the case of wounds created by human bites and certain animal bites.

What are the possible complications of wound closure?

The possible immediate complications of wound closure include:

  • Hematoma (collection of blood under the skin)
  • Wound infection

The possible late complications include:

  • Scar (permanent stitch marks)
  • Keloid formation (rubbery formations on the skin due to overgrowth of the scar tissue)
  • Wound necrosis (accumulation of dead cells that can delay wound healing)

How to improve wound healing?

A sutured wound should usually be 

  • Kept dry for the first 24 hours to avoid infection.
  • Washed off with the dirt and crust.

Ask your doctor when you can start cleaning the area and how to do it. Ask your doctor when you should put or replace the bandage.

  • You need to take care of your wound by
  • Not picking at it.
  • Not swimming until the stitches are removed.
  • Taking care to avoid bumps or bruising.
  • Covering the wound to protect it from strong sunlight.

You should consume a high-protein diet along with an adequate amount of vitamins and minerals that accelerate the wound healing process.

When to call the doctor after wound closure?

You need to observe your wound to look for any signs of infection and call the doctor if you find any such signs. Here is how you can know if your wound becomes infected.

  • Increase in wound pain
  • Worsening of redness around the wound
  • Swelling around the wound
  • Oozing (pus) from the wound
  • Unintentional wound bleeding
  • Wound smells bad
  • You develop fever


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Wound Closure Technique. Available at: https://emedicine.medscape.com/article/1836438-overview