Wound Careの記録を書く時、治癒過程がどんなタイプで行くのかが記載される場合があります。Wound closure typeは、資格試験のテスト問題にもなるし、ここで、ちょっと復習したいと思います。キーポイント／キーワードを挙げてみます。
Primary wound closure (primary intention) ー surgical closure, suture, staples, skin adhesive (skin glue), or dermal-clips. Lower infection risk. Healing is by epithelialization and connective tissue deposition (Azmat, 2022).
Dermal-clips: refer DermaClip website.
Secondary wound closure (secondary intention) ー wounds are left open for granulation tissue formation. Wound healing are by granulation, contraction, and epithelialization. Typically, chronic wounds. Higher risk for infection (Azmat, 2022).
Wound closure with NPWT is a treatment tool to help secondary intention (Dumville et al., 2015). Surgery後にすぐに閉じられるわけではないし、また、上記のgranulation, contraction, epithelializationを満たしています。
Tertiary wound closure (third intention / delayed primary closure) ー delayed wound closure after a period of time (4-6 days). Wound is possibly closed mechanically after thorough exploration, irrigation, and debridement. Delayed surgical closure or skin graft application (Azmat, 2022; Chhabra, 2017).
Third intention occurs when secondary intention is intentionally interrupted (Chhabra et al., 2017)
Reference
Azmat CE, Council M. Wound Closure Techniques. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470598/
Chhabra S, Chhabra N, Kaur A, Gupta N. Wound Healing Concepts in Clinical Practice of OMFS. J Maxillofac Oral Surg. 2017 Dec;16(4):403-423. doi: 10.1007/s12663-016-0880-z. Epub 2016 Mar 5. PMID: 29038623; PMCID: PMC5628060. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628060/#:~:text=Tertiary%20healing%20(third%20intention)%20is,after%20granulation%20tissue%20has%20formed.
Dumville JC, Owens GL, Crosbie EJ, Peinemann F, Liu Z. Negative pressure wound therapy for treating surgical wounds healing by secondary intention. Cochrane Database Syst Rev. 2015 Jun 4;(6):CD011278. doi: 10.1002/14651858.CD011278.pub2. PMID: 26042534.