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
, 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 Presence of slough or
superficial or deep soft necrotic tissue. Black, gray, or brown
wound if it is clean Liquid to semiliquid adherent necrotic
and pink in slough with exudate tissue called eschar.
appearance, ranging from creamy Possible presence of
possible presence ivory to yellow-green. purulent drainage.
of
serosanguineous Risk of wound infection
drainage, pink to increases in proportion
bright or dark red to amount of necrotic
healing, or chronic tissue present.
wound with
granulating tissue.
Protection and Wound cleansing to Debridement of eschar
gentle atraumatic remove nonviable and nonviable tissue.
cleansing. tissue and absorb
excess drainage.
Skin tears, Wounds with nonviable Full-thickness or third-
pressure ulcers necrotic tissue, which degree burns, pressure
(stage II), partial- creates an ideal ulcers (stages III and
thickness or situation for bacterial IV), and gangrenous
second-degree growth and therefore ulcers.
burns, and wounds must be removed.
created by trauma
or surgery that are
, ADULT HEALTH NR 324 ROK 3
allowed to heal by
secondary
intention.
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
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
, 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 Presence of slough or
superficial or deep soft necrotic tissue. Black, gray, or brown
wound if it is clean Liquid to semiliquid adherent necrotic
and pink in slough with exudate tissue called eschar.
appearance, ranging from creamy Possible presence of
possible presence ivory to yellow-green. purulent drainage.
of
serosanguineous Risk of wound infection
drainage, pink to increases in proportion
bright or dark red to amount of necrotic
healing, or chronic tissue present.
wound with
granulating tissue.
Protection and Wound cleansing to Debridement of eschar
gentle atraumatic remove nonviable and nonviable tissue.
cleansing. tissue and absorb
excess drainage.
Skin tears, Wounds with nonviable Full-thickness or third-
pressure ulcers necrotic tissue, which degree burns, pressure
(stage II), partial- creates an ideal ulcers (stages III and
thickness or situation for bacterial IV), and gangrenous
second-degree growth and therefore ulcers.
burns, and wounds must be removed.
created by trauma
or surgery that are
, ADULT HEALTH NR 324 ROK 3
allowed to heal by
secondary
intention.
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
