equis - Articles
Wound: healing – second intention
Introduction
- Wound left to heal by natural process of wound healing Wound: healing – stages, ie closure is achieved by contraction and epithelialization.
Uses
- Large skin defects.
- Severe contamination/infection.
- Significant necrotic debris or exudate within wound.
- Body wounds and upper limb wounds.
Advantages
- Infection less likely than with primary Wound: primary closure or secondary closure Wound: secondary closure.
- May be financial benefits.
Disadvantages
- Scar tissue results.
- Prolonged healing time.
- Wounds below carpus and tarsus heal poorly (secondary closure Wound: secondary closure usually attempted).
- Exuberant granulation tissue common in lower extremities.
- Often poor cosmetic and functional end result.
Technical problems
- Excessive/exuberant granulation tissue (proud flesh).
Alternative techniques
Primary closure
- Wound suture Wound: primary closure.
- Wound sutured to allow first intention healing with minimal epithelialization or formation of granulation tissue.
- Indications: clean, clean-contaminated or contaminated wounds Wound: types – overview, no or minimal skin defects, no severe compromise to blood supply at wound edges, minimal motion between wound edges, minimal surrounding soft tissue damage, ie surgical wounds.
Secondary closure versus second intention healing
- Wounds with large skin defects or severe contamination/infection usually left to heal by second intention.
- Second intention healing when cosmetic outcome unimportant.
Delayed primary closure
- Primary closure Wound: primary closure is delayed until wound is free of signs of infection or necrotic debris has been removed, but prior to fibroplasias (formation of granulation tissue).
- Indications: contaminated wounds Wound: types – overview.
Delayed secondary closure
- Secondary closure Wound: secondary closure.
- Primary closure is delayed until fibroplasia (granulation tissue) has formed in the wound.
- Advantage: granulation tissue → decreased risk of subsequent infection.
- Disadvantage: skin less mobile → undermining skin edges required for complete closure.
Time required
Preparation
- 10-20 min depending on the size and depth of wound. See Wound: preparation.
Procedure
- Depends on the size of the wound 5-30 min, depending on degree of contamination to clean, debride Wound: debridement and lavage Wound: lavage.
Decision taking
Criteria for choosing procedure
- Large skin defects.
- Severe contamination/infection.
- Significant necrotic debris or exudate within wound.
- Body and upper limb wounds.
Risk assessment
- Underlying/adjacent structures, musculoskeletal stability.
Requirements
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Preparation
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Procedure
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Aftercare
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Eggleston R B (2018) Wound management: wounds with special challenges. Vet Clin North Am Equine Pract 34 (3), 511-538 PubMed.
- Ludwig E K & van Harreveld P D (2018) Equine wounds over synovial structures. Vet Clin North Am Equine Pract 34 (3), 575-590 PubMed.
- Maher M & Kuebelbeck L (2018) Nonhealing wounds of the equine limb. Vet Clin North Am Equine Pract 34 (3), 539-555 PubMed.
- Caston SS (2012) Wound care in horses. Vet Clin North Am Equine Pract 28 (1), 83-100 PubMed.
- Quinn G (2010) Equine practice: management of large wounds in horses. In Pract 32 (8), 370-381 VetMedResource.
- Petersen S L, Botes C, Olivier A & Cloud G L (1999) The effect of low level laser therapy (LLLT) on wound healing in horses. Equine Vet Educ 31 (3), 228-231 PubMed.
- Wilmink J M, Stolk P W, Van Weeren P R & Barneveld A (1999) Differences in second-intention wound healing between horses and ponies, macroscopic aspects. Equine Vet J 31 (1), 53-60 PubMed.
- Wilmink J M, Van Weeren P R, Stolk P W, Van Mil F N and Barneveld A (1999) Differences in second-intention wound healing between horses and ponies, histologic aspects. Equine Vet J 31 (1), 61-67 PubMed.
- Trotter G W (1989) Techniques of wound closure. Vet Clin North Am Equine Pract 5 (3), 499-511 PubMed.
Other sources of information
- Hendrickson D A (2019) Superficial Wounds, Deep and Chronic Wounds, Sinus Tracts, and Fistulas. In: Equine Surgery. 5th edn. Eds: Auer J A & Stick J. Saunders, USA. pp 403-425.
- Theoret C (2005) Wound Management: An Issue of Veterinary Clinicians. In: Equine Practice. Eds: Turner S & Theoret C. Saunders, USA. pp 1-240.