Promoting Second Intention Wound Healing - How to Achieve the Desired Result with Evidence-Based use of Dressings and Innovative Physical Methods

When a surgical wound dehisces or when tissue loss dictates it (e.g. in accidental wounds or after excision of masses), wounds will have to heal by second intention. While often useful, skin grafting may have certain limitations in terms of success rate and/or costs. When skin grafting is not an option, the surgeon must resort to supporting healing through application of dressings or use of devices that promote the pathophysiological events (inflammation, hyperplasia and maturation) that eventually lead to wound closure.

Dressings

The primary means to promote second intention healing are to select dressings that stimulate the desired pathophysiologic process in the wound bed¹ . To remove necrosis, the surgeon should add moisture by applying a hydrogel or hydrocolloid dressing; to enhance ingrowth of granulation tissue, alginate or hydrofiber dressings are appropriate choices, as these stimulate fibroplasia; to achieve ingrowth of epithelial cells, the wound is best dressed with a foam dressing, which enhances neoepithelialisation by maintaining an appropriate moisture balance at the wound surface; in the late stages of healing, a film dressing can be applied to maintain a slightly moist wound bed and to protect against contamination. Varying the type of dressing throughout the course of healing is thus crucial for obtaining fast wound closure. To choose the most useful dressing, the wound there needs to be carefully assessed at each bandage change¹ . [...]