The terms primary and secondary intention are appro-
priate for descriptions of bone repair. If a bone is frac-
tured* and the free ends of the bone are more than 1 mm
or so apart, the bone heals by secondary intention; that
is, during the fibroplastic stage of healing a large amount
of collagen must be laid down to bridge the bony gap
(Fig. 4-6). The fibroblasts and osteoblasts actually produce
so much fibrous matrix that the healing tissue extends
circumferentially beyond the free ends of the bone and
forms what is called a callus (Fig. 4-7).
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Types of Wound Healing



1.) Healing by first intention

aka. primary wound healing or primary closure
Describes a wound closed by approximation of wound margins or by placement of a graft or flap, or wounds created and closed in the operating room.
Best choice for clean, fresh wounds in well-vascularized areas
Indications include recent (<24h old), clean wounds where viable tissue is tension-free and approximation and eversion of skin edges is achievable.
Wound is treated with irrigation and débribement and the tissue margins are approximated using simple methods or with sutures, grafts or flaps.
Wound is treated within 24 h following injury, prior to development of granulation tissue.
Final appearance of scar depends on: initial injury, amount of contamination and ischemia, as well as method and accuracy of wound closure, however they are often the fastest and most cosmetically pleasing method of healing.

2.) Healing by second intention

aka. secondary wound healing or spontaneous healing
Describes a wound left open and allowed to close by epithelialization and contraction.
Commonly used in the management of contaminated or infected wounds.
Wound is left open to heal without surgical intervention.
Indicated in infected or severely contaminated wounds.
Unlike primary wounds, approximation of wound margins occurs via reepithelialization and wound contraction by myofibroblasts.
Presence of granulation tissue.
Complications include late wound contracture and hypertrophic scarring

3.) Healing by third intention

aka. tertiary wound healing or delayed primary closure
Useful for managing wounds that are too heavily contaminated for primary closure but appear clean and well vascularized after 4-5 days of open observation. Over this time, the inflammatory process has reduced the bacterial concentration of the wound to allow safe closure.
Subsequent repair of a wound initially left open or not previously treated.
Indicated for infected or unhealthy wounds with high bacterial content, wounds with a long time lapse since injury, or wounds with a severe crush component with significant tissue devitalization.
Often used for infected wounds where bacterial count contraindicates primary closure and the inflammatory process can be left to débribe the wound.
Wound edges are approximated within 3-4 days and tensile strength develops as with primary closure.
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