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The process of wound healing is generally divided into four stages: inflammation, fibroblast proliferation, contraction, and remodeling. There are three types of wound healing:

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  • First intention. The wound is closed by routine primary suturing, stapling, or gluing. Epithelialization occurs in 24–48 h.
  • Secondary intention. The wound is not closed by suturing, stapling, or gluing but closes by spontaneous contraction and epithelialization at a rate of 1 mm/d). Most often used for wounds that are infected and packed open.
  • Third intention (also called delayed primary closure). The wound is left open for a time and then sutured at a later date. Often used with grossly contaminated wounds.

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Used for healing both acute and chronic wounds. Continuous negative pressure is distributed over the wound surface. The system consists of a soft sponge cut to fit and occupy the volume of the wound, a plastic tube imbedded in the center of the sponge and extending out of the wound to a controlled suction pump, and a gas- and fluid-impermeable plastic outer film that adheres to the back of the sponge and the surrounding normal skin. Vacuum-assisted closure allows “active” removal of extracellular debris (exudate). Soft-tissue defects heal faster when subatmospheric pressure is applied. Used for wounds resulting from pressure, trauma, infection, IV extravasation, A–V insufficiency, and skin grafting.

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Table 17–1 Common Absorbable Suture Materials
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Table 17–2 Common Nonabsorbable Suture Materials
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Suture materials can be broadly defined as absorbable and nonabsorbable. Absorbable sutures can be thought of as temporary and include plain catgut, chromic catgut, and synthetic materials such as polyglactin 910 (Vicryl), ...

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