Wound Closure Part 1: Revisiting the Science

Dr. Keyvan Abbaszadeh
Oral & Maxillofacial Surgeon, London ON

In the first of a two-part presentation on wound closure, Dr. Keyvan Abbaszadeh, an oral maxillofacial surgeon from London ON, takes a detailed look at the science behind wound healing. In conversation with Dr. John O’Keefe, Director of Knowledge Networks CDA, Dr. Abbaszadeh outlines the complex physiological processes at play, and walks through the three types of wound closure commonly experienced in surgery.

Here are the key takeaways from the conversation:

• Wound healing is a complex and fragile physiological process that is susceptible to interruption or failure. It involves various cell types, molecular mediators and structural elements.
• There are four stages of wound healing:
  • Hemostasis
  • Inflammation
  • Proliferation
  • Remodelling
• Most wounds will eventually heal, though there are some instances where an underlying medical issue or mechanical interference will not allow it to heal.

Objectives of wound closure

• Hemostasis
• Patient comfort
• Protect underlying structures
• Protect dental repairs/devices etc.
• Decrease chance of infection
• Separate anatomic boundaries
• Repair vital structures

Types of wound closure

Primary Intention

• A clean wound with no tissue loss
• Edges brought and held together
• Suture, staples, glue
• Very little scarring

Secondary Intention

• Sizeable tissue loss/damage
• Heal from a bed of granulation tissue
• Broader scar
• More wound care needed
• Extraction sockets heal by secondary intention

Tertiary Intention (delayed primary closure)

• Wound is left open on purpose
• Cleaned, debrided, packed and then sutured
• Large, contaminated, complex wounds

We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
CDA Oasis Team