ADULT HEALTH NR 324 ROK 3

1. Explain the process of wound healing by primary, secondary, and tertiary intention.

Primary Intention.

Primary intention healing takes place when wound margins are neatly approximated, as in a

surgical incision or a paper cut. A continuum of processes is associated with primary healing.

These processes include three phases.

A. Initial Phase.

In the initial (inflammatory) phase, the edges of the incision are first aligned and sutured (or

stapled) in place. The incision area fills with blood from the cut blood vessels, blood clots form,

and platelets release growth factors to begin the healing process. This forms a matrix for WBC

migration. An acute inflammatory reaction occurs.

B. Granulation Phase.

The granulation phase is the second step. The components of granulation tissue include

proliferating fibroblasts; proliferating capillary sprouts (angioblasts); various types of WBCs;

exudate; and loose, semifluid, ground substance.

C. Maturation Phase and Scar Contraction.

The maturation phase, during which scar contraction occurs, overlaps with the granulation phase.

It may begin 7 days after the injury and continue for several months or years. This is the reason

abdominal surgery discharge instructions limit lifting for up to 6 weeks. Collagen fibers are

further organized, and the remodeling process occurs. Fibroblasts disappear as the wound

becomes stronger.

Secondary Intention.

Wounds that occur from trauma, ulceration, and infection have large amounts of exudate and

wide, irregular wound margins with extensive tissue loss. These wounds may have edges that

cannot be approximated (brought together). The inflammatory reaction may be greater than in

primary healing. This results in more debris, cells, and exudate. The debris may have to be

cleaned away (debrided) before healing can take place.

The process of healing by secondary intention is essentially the same as healing by primary

intention. The major differences are the greater defect and the gaping wound edges. Healing and

granulation take place from the edges inward and from the bottom of the wound upward until the

defect is filled. There is more granulation tissue, and the result is a much larger scar.

Tertiary Intention.

Tertiary intention (delayed primary intention) healing occurs with delayed suturing of a wound

in which two layers of granulation tissue are sutured together. This occurs when a contaminated

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ADULT HEALTH NR 324 ROK 3

wound is left open and sutured closed after the infection is controlled. It also occurs when a

primary wound becomes infected, is opened, is allowed to granulate, and is then sutured. Tertiary

intention usually results in a larger and deeper scar than primary or secondary intention.

2. Explain the red-yellow-black wound concept (description, characteristics, give

examples)

Red Wound Yellow Wound Black Wound

Can be a superficial

or deep wound if it is

clean and pink in

appearance, possible

presence of

serosanguineous

drainage, pink to

bright or dark red

healing, or chronic

wound with

granulating tissue.

Presence of slough or soft

necrotic tissue. Liquid to

semiliquid slough with

exudate ranging from

creamy ivory to yellowgreen.

Black, gray, or brown

adherent necrotic tissue

called eschar. Possible

presence of purulent

drainage.

Risk of wound infection

increases in proportion to

amount of necrotic tissue

present.

Protection and gentle

atraumatic cleansing.

Wound cleansing to

remove nonviable tissue

and absorb excess

drainage.

Debridement of eschar and

nonviable tissue.

Skin tears, pressure

ulcers (stage II),

partial-thickness or

second-degree burns,

and wounds created

by trauma or surgery

that are allowed to

heal by secondary

intention.

Wounds with nonviable

necrotic tissue, which

creates an ideal situation

for bacterial growth and

therefore must be removed.

Full-thickness or thirddegree burns, pressure

ulcers (stages III and IV),

and gangrenous ulcers.

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ADULT HEALTH NR 324 ROK 3

3. Explain surgical, mechanical, autolytic, and enzymatic debridement.

Surgical debridement

 Quick method of debridement to

prevent, control, or remove infection.

 Used when large amounts of

nonviable tissue are present.

 Prepares wound bed for healing,

skin grafting, or flaps.

Mechanical debridement

 Wet-to-dry dressings in which

open-mesh gauze is moistened with

normal saline, packed on or into wound

surface, and allowed to dry. Wound

debris adheres to dressing and then

dressing is removed.

 Wound irrigation. Make certain

bacteria are not accidentally driven into

wound with high irrigation pressure.

 Whirlpool. Should not be used in a

clean granulating wound. Used when

minimal debris is present. Nonselective

and will also debride some healthy

tissue.

Autolytic debridement

 Semiocclusive or occlusive

dressings used to soften dry eschar by

autolysis.

 Assess area around wound for

maceration when using these dressings.

 Malodorous.

Enzymatic debridement

 Drugs applied topically to dissolve

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