Categories of wound closure

Closure by primary intent:

This refers to wound closure immediately following the injury and prior to the formation of granulation tissue. In general, closure by primary intent will lead to faster healing and the best cosmetic result. Most patients presenting within 8 hours of injury can have the wound closed by primary intent. Simple and clean facial wounds, by virtue of the rich vascular supply to the face and the need for a good cosmetic result, can be closed by primary intent as late as 24 hours after the injury.

Closure by secondary intent:

This refers to the strategy of allowing wounds to heal on their own without surgical closure. Of course the wound should be cleaned and dressed as with any wound. Certain wounds such as small partial thickness avulsions and fingertip amputations are best left to close by secondary intent.

Closure by tertiary intent:

This refers to the approach of having the patient return in 3-4 days, after initial wound cleansing and dressing, for wound closure. This is also referred to as delayed primary closure. Closure by tertiary intent is used for patients with wounds who present late (>24 hours) for care, contaminated crush wounds and mammalian bites when leaving the wound open would result in an unacceptable cosmetic result.