Intentions: Primary, Secondary, Tertiary!

In many medical texts, one encounters the word "intention", that makes many students confused! Intention!? Yes, but it primarily means "healing" in medical contexts:


۱٫ Primary Intention (Also: Primary closure)PI


The healing of an incised wound by the direct union of skin edges without granulations


– When wound edges are brought together (sutured/glued) so that they are adjacent to each other (re-approximated),

– Minimizes scarring,

– Most surgical wounds heal by primary intention healing,

– Wound closure is performed with sutures (stitches), staples, or adhesive tape or glue.

Examples: well-repaired lacerations and well reduced bone fractures.


۲٫ Seconday Intention (Also: Spontaneous healing)SI


The healing of an incised wound by granulations that bridge the gap between skin edges


– The wound is allowed to granulate,

– Surgeon may pack the wound with a gauze or use a drainage system,

– Granulation results in a broader scar,

– Healing process can be slow due to presence of drainage from infection,

– Wound care must be performed daily to encourage wound debris removal to allow for granulation tissue formation.

Examples: Tooth extraction sockets, poorly reduced fractures, burns, severe lacerations, pressure ulcers.

۳٫ Tertiary Intention (Also: Delayed primary closure or secondary suture)TI


When a wound is intentionally kept open to allow edema or infection to resolve or to permit removal of exudate


– The wound is initially cleaned, debrided and observed, typically 4 or 5 days before closure,

– The wound is purposely left open.

Examples: healing of wounds by use of tissue graft.




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