Wounds and healing 6, Primary and secondary healing
ฝัง
- เผยแพร่เมื่อ 23 ก.พ. 2014
- Healing by primary intention
A wound will heal by primary intention if the edges of the wound can be approximated together. Some form of wound closure is normally employed to keep the wound edges closed. Common ways of achieving closure and stability of the wound edges include adhesive strips, sutures or super glue.
Advantages of healing by primary intention
Approximation and stabilisation will allow the edges of a wound to heal directly into each other. In primary healing the process is fairly rapid, normally wound edges will be closed with sufficient tensile strength to remove the sutures after 7-10 days. However, it takes much longer than this to restore full strength to the wound, even after 2 weeks the wound only has 20% of full strength. If the edges of a wound are closed, the surface area of the wound is reduced. This means that there will be a minimal amount of scar tissue formed, giving good cosmetic and functional results. As the wound is closed, there is less opportunity for secondary colonisation or infection to enter the wound from outside sources of microbiological contamination.
Potential problems with primary intention
Because the wound edges are closed, there is the possibility that foreign material or bacteria may be enclosed within the wound. This will allow any bacteria present to multiply and lead to wound infection with possible abscess formation. Also the presence of foreign material can lead to future complications such as pain and damage to tissues. If foreign material can be removed before closure, this particular complication may be prevented; this is one reason why wound exploration is so vital. If the wound is likely to be contaminated with bacteria from the implement which made the wound, then again it is unwise to close the wound, unless the practitioner feels they are able to adequately wash away the contamination with irrigation or other wound cleaning procedures. When primary healing is not possible, or is not advisable, healing by secondary intention will be used.
your lectures are simple and with great comprehensiveness.. thanks Dr.
The best teacher to listen too
I'm a Vietnamese medical student, after listening this lesson, all I have to said that it is incredibly easy to understand. Thank you so much and wish you have a lot of health!
Love your scientific material , Love your technique of delivering information and simplicity
Dr you just inspire me , Thank you very very much
Thank you, you make things much easier to understand, excellent teaching skills
Wow! Dr. Campbell you are an amazing teacher.
Now he is an Excellent teacher.....explaination is perfect easy and simple to understand, direct to the point.
Thank you so much Dr. Campbell , your voice is very soothing BTW. Cheers! =))
Currently experiencing healing by secondary intent after cyst removal surgery in my underarm got infected after healing by primary intent. Thank you for giving me this information and reassuring me that this open wound I have is semi-normal!
Thank you Dr John, I’m dealing with a recurrent pilonidal sinus wound with my son. His mobility is reduced and he is doubly incontinent. The sinus opens spontaneously once inflammation builds up from body hair. Unusually It’s been open these past 7 months and because of Covid I’ve had little or no input from GP (as it’s been impossible to contact them) until recently when it required antibiotics as it began to smell fishy. Since viewing your videos I’ve been spraying the pocket type wound with previously boiled salt water gauze, drying with gauze and packing it with a ribbon dressing and it’s finally beginning to respond and the wound has become much more shallow with (what I now know is) granulation tissue. I was worried at first because I thought the granulation tissue was a bad thing! Now I realise it’s where it’s healing. I’m now going to add in a daily recommended dose of vit C and Zinc to his limited diet.
I m facing same sinus issue. My wound deeper 2CM and 3 CM wider. Help me on fast tissue recovery methods?
This is exactly the info I have been looking for. Thank you!
Thank you professor! u made it understandable I will use this in my next exam in some days ^^
Thank you so much Professor Campbell.
Brilliant; concise and incredibly helpful!
Thank you for your amazing explanations
So many things packed in a small 13 minutes long video. Thank you very much Sir
Im not a nursing student but have a natural interest in accumulation of this kind of super useful info. Ice had to care for many good sized wounds.
Thank you very much I really like your nice useful lectures
Great lecture
Very smart and excellently presented. Thank you sir.
I wish my teacher taught like you
Thanku so much
love your videos - very helpful thank you !
Thanks! Great as always!
Thank you for this video, it was very helpful and well explained. It's amazing to think this information will be helping me for whenever a patient comes in with a wound once I become a pharmacist :)
Really understandable and straight to the point lecture
thank u so much , u are a good teacher , keep going .
I must comment again. Thank you. I’ve been to the hospital some four times now. Thanks for enlightening me.
Thanks prof, you made that really simple
This is excellent explanation. I would definitely use for my exams
Thank you so much professor! It's so helpful!
You are explaining this better than my goddamn book that I paid like 90euros for. Real glad that there is so much good supplementary study material online. Now I just gotta get over having weak hands when training wound care.
Thanks Dr
surely i was mixing these primary and secondary intent with the stages of wound healing
Thank you sir..u always make the concept easily understandable
Wow really made simple thank u dr.
very understandable, thank you.
thanks so much DR :D
excellent explanation !
awesome explanation....tysm
I actually really like this Dr.
Thanks for a simple and very informative discussion on various types of wound healing. Bravo!
Wow. I found you last year during that shit show. I’ve had a wound not healing for a while and I found you again. 🙏🏼
Thank you. ..professor. ...
I now understand what is going on with a wound I have on my foot... Great video!
Is you foot fully better now?
Listened you from pakistan .
Love the way you express the topic .
Covered nicely 👍 👌
great stuff!!
Thanks Doc
Thank you Dr.
I have a deep second degree burn on my leg so this has helped me to understand the healing process.
very helpful and simply put
Nice video Doctor
Excellent explanation
Good work professor
thank you!!!!
Thank you
Thank you so much 😊
Thank you Dr that was very helpful
Excellent explanation 👍
thank you dear
Thank you so much sir
Thank you so much for sharing this information! I got struck by a car and had a head wound treated by suture. After removing the sutures, the nurse discovered a 2 cm whole under the sealed surface...I was really worried about healing, but after watching your video, at least I know what I need to worry about, and it'd make the communication with doctors easier. I really wish I could get better soon!
Yes, I also wish it will get better soon. Are you now being well treated by health care professionals?
@@Campbellteaching Thank you for replying! Yes, fortunately I live quite close to a hospital. I think last time the nurse put a vaseline gauze into the hole. They will change the dressing today.
@@hopezhang8278 Good, do eat a nutricious diet as well, eg. vitamin C and zinc are needed for wound healing.
@@Campbellteaching Thank you, will do. I'm also trying not to eat too much though. My appetite isn't back yet, and found eating too much meat or protein quite taxing on my stomach.
@@hopezhang8278 eating more protein than you need won't help anyway, but do consider the vitamin C
You are best
Best explanation
Thank you professsor
Amazing
this was great, studying for a quiz in my fundamentals of nursing course. however they mentioned the third process being called tertiary intention, where the wound is left open on purpose to control infection and is closed at a later time creating a larger and deeper scar.
thank you sir
Pilondial cyst surgery two weeks ago my doctor was surprised how fast my wound is healing and it’s almost closed 🙏 I shower and sit in the sitz bath three times a day and pack it and also taking vitamin c and zinc 👍
omg, it is sososososo helpful.
He’s the man
Thank you Dr. Campbell , after searching for information and trying to understand what is going on with my partners Stoma reversal wound healing we now understand why it’s taken so long . Finally after almost 6 months he has gone from having 4 strips of aquacel packing to just 1 of 5cm. However, he does have a slightly red sore area on the very outside edge of the skin so we are wondering if you may have the answer as to why this is . Also , along the way he’s had 2 infections, both E.Coli , is this fairly normal with such a deep wound ?.
Very interesting
Thanks alot
Cool seeing your work before all of the Covid stuff. Doc left the incision wide open, which just seems weird.
Prof Donald Wilhelm NSW FOUNDING PROF pathology 1969 75
Wilhelm's research interests were recorded in some fifty-six papers and seven chapters of books. He made three lasting contributions to understanding of the inflammatory response. First, he analysed the dynamics of vascular permeability changes (vessel leakage), brought about by injury. He stressed the use of mild stimuli to cause minimal damage so the detailed cellular events could be readily defined. Secondly, he and Miles, in analysing chemical mediators of inflammation, characterized globulin permeability factor, now recognized as a trigger for bradykinin production. Thirdly, they defined criteria for characterizing chemical mediators from tissues.
As an investigator Wilhelm was methodical, industrious and persistent. His friend Trevor Dinning stated that he was 'always a well organised and committed person', who appreciated elegant techniques in the experimental setting where tissue reactions could be manipulated. He liked the clean-cut, well defined experiment illustrated in many of his own studies on vascular permeability changes in inflammation. He was exacting in writing up his papers and those of his students.
Well apparently I had not one, but multiple doctors who did not know some of this stuff, and did not know how to correctly treat a wound- -specifically a cat bite. Got bitten, and I immediately took an antibiotic that I had in my medicine cabinet. It was midnight, so next day, went to one of those urgent care clinics--you can probably guess which one--they are on practically every corner in the US now. In addition to an antibiotic, they gave me an antimicrobial. Antimicrobial was prescribed for only once a day. That didn't sound right to me, a person of non-medical background. So I asked to make sure. They said yes. Well, they were WRONG! After multiple follow-ups, the second or third DIFFERENT doctor had increased the dosage of the antimicrobial, but by that time it was too late. The wound soon abcessed, popped open, and I squeezed out all the gunk and flushed out what was now a gaping hole in my leg. I went back to the same urgent care, and the different-again doctor literally did not know what to do. He looked at me with a dumbfounded look on his face and told me to go to the nearby emergency center. The doctor there looked at it and said, looks good, you did a great job cleaning it out. I'll send someone in to bandage and wrap it up again. I said no thanks, I'm a pro at that now, because it had been several weeks by then. I asked about stitches, and she was afraid to stitch it up because she was afraid of another abcess. Well the dang gaping hole wasn't healing. So I took some bandage tape and made my own butterfly stitch. Guess what? It started to close up and heal after that...Go figure...Not without a big hard lump of scar tissue underneath though. I am still massaging it out.
Dumba$$es! Can you believe that? I paid for that stupid $hit!
Very educational video professor. If I possible to request. Can you make a video explaining how trichloroacetic acid (tca) can be used to close pitted acne scars/ice pick scars. I expect the ground theory is quite similar to what you have explained on closing wound. Thx
Heck, I don't know that one, does it work?
Years of experience ...can be seen..
I have an open wound from surgery to remove a seroma from my left chest (mastectomy 12 months ago). The surgery was 6 weeks ago and the community nurses have been dressing it daily. It’s nice and clean but it’s not healing in a hurry. I had radiotherapy to the area in January this year and have lymphodema. Is there any thing I could do to promote healing? The depth is 4cms ,
Sir its so concise thanku can u please upload on shock ..hypovolumic shock and septic shock mainly
There is a series on shock, have you watched them?
Dr will you please share your opinion on wound vac 🙏🏾 thank you
anyone know if it'd be wrong to add powdered zinc and collagen peptides to a stage 4 pressure sore before packing it and repeating that process 2 to 4x a week?
Very good professor. But if the patient is diabetic?
Thank you Dr. Campbell!
I have an exam question that I like to hear your opinion about them:
1. Trauma patient has a wound on the thigh that exposes the muscle and nerves below, how will you manage it ? A. Debridement with secondary closure. B. Debridement with delayed primary closure ?
Also, can we close 8cm diameter wound be delayed primary closure ?
Several factors can influence the answer to your question. It the wound on the thigh is relatively narrow and the edges can be approximated, and the wound is relatively clean and free from high energy contamination, then a layered primary closure is certainly an option.
However, if there were devitalised tissue that will necrose, then a delayed primary cloister after debridement and wound cleaning might be more appropriate.
For an 8 cm wound, well it depends on the area of the body effected, and how elastic the involved tissues are. Grafting might be an option in this case.
primary healing
- approximate the edges of the wound (direct closure with two sides of injuries)
secondary healing
- loss substantial amount of tissue
- leave the wound open
- granulation will occur from the edges of the wound and progressing filling the tissue loss
Sir I have a injured eyebrow and have a wound and I just use bandage and strips to close the wound now my wound is healed and have scar but I notice when I stretch my eyebrow there is a lump. And I think it's a excess skin. Don't hurt and no pain. What should I do? Do I need to scar revision?
How long to be heald the deep wound. Like inguinal hernia surgery with mesh.? Thank you..
Wound healing partly depends on if its primary or secondary intention, primary healing is usually faster of course.
@@Campbellteaching thank you doc. It is normal if the surgery wounds pain after almost two months. But my wounds outside is already healed. It's normal I felt pain.
Hello Dr. Campbell, I was just wondering what the ideal temperature for wound healing would be ? Or if there is such a thing as an ideal temperature?
Yes, the temperature at which cellular enzymes function at their optimum levels, i.e. 37'C
OK, thanks for the answer :) but that sounds very hot...? Do they have temperatures like this in hospital rooms for patients after surgery?
No, people would feel too hot, but internal wounds will heal at that normal body temperature, as will wounds in the mouth after dental extractions. Wound cooling is a well know adverse factor in wound healing.
OK, I understand. Thanks for the answer :)
it should be higher than normal to kill any anaerobic bacteria, or to help bring in more cytokines
I'm p3 and I'm watching lol
what is p3?
@@Campbellteaching it's not a big deal
But sir, granulation tissue starts growing from center to peripheral, but you said that from peripheral to center(7:25) ....how ??
Thanks , its very helpfull , but i want to know have any relationship btween regenaration and primary healing ? or any relationship btween fibrosis and secondary healing ?
Secondary healing is associated with increased fibrous tissue production from fibroblasts
@@Campbellteaching
Thank you doctor.
@@okk2101 I would say there is also more regeneration in primary healing as there is a shorter distance for cell migration to take place over. Of Course, primary healing can still leave a scar, as you will see form any surgical scar.
Yeah
great video but could you use a whiteboard next time? the sound is the marker is very harsh
What is the need to remove the necrotic tissue? Plz someone..
Go to settings... playback speed: 1.75. Thank me later.
Thank you lol
I prefer 2
@@MedPerspect yeah? I prefer 100x tho
works for long tarot readings also😃
Thanks prof, you made it understandable, but can u please use whiteboard insted of this noisy one 👽🤦🏼♀️
Hey doctor...nice video..understandable 👍💥
do you treat a lot of wounds?
@@Campbellteaching No..I am still in college studying MBBS from India.Pathology is the subject in my upcoming annual exam😅
@@dr.shubhamaware3257 Good, I expect you will treat wounds when you are practicing, there are plenty of wounds in India to treat.
Nothing more painful than regrowing skin over a large portion of your body.
What should we eat to make the secondary healing process fast
Diet and supplements will only improve healing if the patient is deficient in something. More common deficiencies include vitamin C, zinc, magnesium, protein.
@@Campbellteaching Hi Doctor🤗
Can you understand me about type inflammation and I be thanks for you☺ Dr☺
@@user-fv7jm5py2e Have you watched the video series I made on inflamma?
@@Campbellteaching No,😔
@@user-fv7jm5py2e th-cam.com/video/cn7EKd1EuCo/w-d-xo.html
6:50 I have this one and I’ve been off antibiotics for 6 days now, and it’s been 11 days since I got the wound and it still looks like just meat. It hasn’t really dried. I wash it twice a day with soap and water to get any bacteria out, and I put on a antibiotic cream once a day, and wrap it. It literally looks like this 🥩. It’s on my elbow. I fell on asphalt going 30mph on a motorbike, and my elbow got shredded. It took all the hit. Is that normal? It’s kind’ve freaking me out.
Don't wet the wound... Just apply fucidic acid cream or any good antibacterial
Reminiscence of PROFESSOR DONALD WILHELM , Pioneer in INFLAMMATION RESEARCH AND EDUCATION. ( NSW UNIVERSITY, PROFESSOR OF PATHOLOGY ) MBBS COURSE. AUTHOR IN HANDBOOK OF PATHOLOGY. FIRST TWO CHAPTERS ON INFLAMMATION. 1969- 1974