Wound Closure and Healing
Basic Information 
Indications
• Primary closure performed within several hours of injury is appropriate for fresh, minimally contaminated wounds, with a good blood supply, not involving vital structures; wounds of the head region; flap wounds with a good blood supply; and wounds of the upper body when a good cosmetic outcome is desired.
• Delayed primary closure performed before granulation tissue formation is appropriate for severely contaminated, contused, or swollen wounds and those that involve a synovial structure.
• Secondary closure performed after granulation tissue formation is used for chronic wounds with a compromised blood supply. The wound is sutured after a healthy bed of granulation tissue develops.
• Second intention healing allows a wound to close by wound contraction and epithelialization and relied upon for large wounds with a tissue deficit involving the body and for highly mobile areas such as the pectoral and gluteal regions.
• Skin grafting is used when tissue deficits exceed the capability of wound contraction and epithelialization.
• Reconstructive surgery is used to improve the cosmetic and functional outcome of a wound.
Procedure
Intralesional injection of 2% concentrations inhibits collagen synthesis and formation of granulation tissue. Epinephrine exacerbates this effect via vasoconstriction.
• Suturing techniques and suture material
• Simple interrupted (SI) when compared to simple continuous sutured skin wounds exhibit:
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