Total of lect: wound healing2 4TH Stage College of Veterinary Medicine

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Secondary union
Secondary wound closure is also referred to as closure by secondary intention. The
skin edges of the wound are not sutured together; the wound is left “open.”
Dressings are applied regularly to keep the wound clean, and the wound gradually
closes and heals on its own.

Differences between primary and secondary union of wounds:
  Factors influencing wound healing:

1. Systemic factors

a) Oxygen

Wound healing is thus not disturbed by anemia. A decrease in the

haemoglobin content is accompanied by a decrease in the viscosity of the
blood, a decrease in peripheral resistance, and an increase in cardiac
output. The oxygen tension therefore remains constant.

b) Proteins

The synthesis of collagen is also delayed by protein deficiency.

One of the most important building blocks for the fibroblast, also reduce
collagen development.

c) Corticosteroids:

Cortisone and adrenocorticotropic hormone (ACTH) have a

stabilizing effect on the lysosome membrane of granulocytes and
macrophages, and impede the migration of macrophages into the wound.
They inhibit the regeneration of endothelial cells, fibroblasts and
epithelial cells, and also have a delaying influence on the synthesis of
collagen and proteoglycans.

d) Vitamin deficiency:

1- vit. A deficiency resulting into impair collagen synthesis.

2- vit. K deficiency which leads to haematoma formation and

serum collection then wound disruption and infection.

e) Age: healing in young animals more quick than old animal.

f) Genetic factors or disease: such as haemophilia.

2- Local factors:

a) Temperature: Wounds heal more quickly at a temperature

of 30°C. If the room temperature is reduced to between
20°C and l2°C, the strength of the wound decreases,
possibly as a result of reflex vasoconstriction.
b) Trauma: The type of injury naturally has an influence on
the course of wound healing. A sharp wound almost
always heals without problems, whereas the process is
markedly inhibited by the presence of dead tissue, foreign
bodies, a haematoma or a seroma. The debris must first be
removed before revascularization and healing can occur.
c) Radiotherapy: Wound healing is often difficult in an
irradiated area. This is due to poor vascularization, an
abnormal inflammatory reaction, and the absence of
regeneration of endothelial cells, fibroblasts and epithelial
cells.
 Complications of wound healing:
1- Venous thrombosis and embolism: Venous thrombosis occurs
frequently because blood flow is slower it occurs due to
phlebitis in the vein that passes through the wounded area.
2- Bleeding: is the escape of blood from the blood vessels...?
3- Shock: a state in which the amount of oxygen delivered to the
tissues is inadequate to maintain normal cellular respiration.
The animal is unconscious.
4- Traumatic fever: Fever occurs due to toxins absorbed from the
wounded area. Treated by the cause.
5- Cellulitis: Spread of infection in the connective tissue
subcutaneously , the affected area tends to suppurate and
 necrotize ,the wound edges are swollen ,hot, painful and treated
by systemic antibiotic, treatment the sign or symptoms and
make drain if need.
6- Damage to nerve: May cause paralysis to the muscles supplied
with that nerve or loss of sensation, may be temporary or
permanent depending on degree of injury.
7- Tetanus: disease caused by toxin of clostridium tetani
incubation period of this disease ( 4-5 days ) sign is slow
mastication dropping of saliva, paralysis of eyelid, nostril is
dilated stiffness of the facial and abdominal muscles, spasm of
muscles is more during noise, stiffness of the limb and tail and
treated with tetanus anti toxoid and sedative drug.

General principles of wounds treatment?

1- pre- operative preparation of the site wound.

2- Sharp dissection.

3- Arrest haemorrhage.

4- Make drainage of wound.

5- Debridement (removal of the dead tissue).

6- Apply chemotherapy or antiseptic.

7- Suture after debridement.