Which statement correctly compares healing by primary, secondary, and tertiary intention, with examples?

Which statement correctly compares healing by primary, secondary, and tertiary intention, with examples?

• A. Secondary intention: edges not closed; heals by granulation and contraction.
• B. Tertiary intention: delayed primary closure with initial open healing.
• C. Primary intention: edges approximated and closed.
• D. Secondary intention: wound is closed with sutures.

Answer: (B)

Healing by intention describes how wounds close and scar over, depending on how closely the wound edges are brought together and whether the wound is closed right away or left open to heal from the inside out. When edges are brought together cleanly and skin is closed, healing happens quickly with minimal scar—that’s primary intention. If the wound edges aren’t closed and healing occurs through granulation tissue, contraction, and eventual epithelialization, you get a longer healing process and typically more scarring—that’s secondary intention. Tertiary, or delayed primary closure, means the wound is left open for a period to allow drainage, cleaning, or reducing infection risk, and is closed later once it's safer to do so. An example is a contaminated surgical wound that is intentionally left open for a few days and then sutured closed once infection risk has lessened. So, the statement that tertiary intention involves delaying closure with initial open healing and later closure correctly captures this approach. While primary intention correctly notes edges approximated and closed, and secondary intention describes healing without early closure through granulation and contraction, the concept of deliberately delaying closure to improve safety is unique to tertiary intention. The idea that a wound with secondary intention is closed with sutures is inaccurate, since closing a wound with sutures describes primary intention.

Healing by intention describes how wounds close and scar over, depending on how closely the wound edges are brought together and whether the wound is closed right away or left open to heal from the inside out. When edges are brought together cleanly and skin is closed, healing happens quickly with minimal scar—that’s primary intention. If the wound edges aren’t closed and healing occurs through granulation tissue, contraction, and eventual epithelialization, you get a longer healing process and typically more scarring—that’s secondary intention. Tertiary, or delayed primary closure, means the wound is left open for a period to allow drainage, cleaning, or reducing infection risk, and is closed later once it's safer to do so. An example is a contaminated surgical wound that is intentionally left open for a few days and then sutured closed once infection risk has lessened.

So, the statement that tertiary intention involves delaying closure with initial open healing and later closure correctly captures this approach. While primary intention correctly notes edges approximated and closed, and secondary intention describes healing without early closure through granulation and contraction, the concept of deliberately delaying closure to improve safety is unique to tertiary intention. The idea that a wound with secondary intention is closed with sutures is inaccurate, since closing a wound with sutures describes primary intention.