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 Healing by primary intention OR by Secondary Intention

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Something_To_Believe_In
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PostSubject: Healing by primary intention OR by Secondary Intention   Sun Jan 03, 2010 1:53 pm

There are primarily two ways to heal a wound.

PRIMARY INTENTION means that the primary purpose of the treatment is to close the wound. This would mean that a wound is stitched/glued/stapled closed. It is healing from the outside-in. The skin heals first, and the other tissues heal last. This occurs most often with surgical incisions and various other clean wounds. Wounds of this type (cuts) heal well with stitching/gluing/etc because the edges of the skin are clean cut.

The pros of this type of healing are that it is widely known - people think "Wound? stitch it up." So, they tend to understand the idea and accept it as part of healing. Additionally, the risk of bacteria getting into the wound is decreased with closing the wound up. The cons are that this healing can appear deceitful, as the skin will close and APPEAR completely healed before the underlying tissues are completely healed. Therefore, it is very easily opened up again. Additionally, any bacteria already in the wound are closed up inside the body, in a very inviting environment, and can cause major infection in a very short time. Often, to prevent this, a drain is inserted. The drain allows for the pus and infection to continue to leave, while at the same time closing most of the wound. A drain requires attention and management several times each day, and a glider with a drain would have to be in an e-collar and isolated from other gliders.

Antibiotics and pain management are crucial with this type of wound healing. It is essential that the glider remain separated from cage mates until fur has grown back in FULLY at the wound site. This helps ensure that the underlying tissues are healed as well.


SECONDARY INTENTION - means that the wound heals from the Inside-Out. The underlying tissues heal first and the last thing to heal is the skin. Therefore, you have an open wound for the largest portion of healing time. This allows for complete healing and careful monitoring of the healing process. This is often the chosen method of healing for wounds inflicted by chewing or ripping - where the edges of the wound are jagged and/or torn.

The pros of this type of healing are that it is a very good method for achieving complete healing without having to have a drain or worry about internal abscess. It is relatively painless for gliders to heal in this fashion, and it has been found that gliders CAN live with cage mates with an open wound healing by secondary intention without the cage mate messing with the wound. (more on this at a later date). Cons are that the wound and environment have to be kept clean, or bacterial infection can set in. The wound is open, and many people cannot understand the process of leaving a wound open and calling it healing.

There is much debate about topical treatment for open wounds. Personally, I do not use much, if any, topical treatment beyond the first week or so. I keep the wound moist until I am confident a scab will not form, then I let it dry out and begin to heal. It is at this point that I am able to put the glider back in with cage mates without them messing with the wound. *** PLEASE NOTE *** I know my gliders well and have a lot of experience with wound management, so I do not recommend placing gliders back with cage mates without consulting a vet AND someone with vast experience who can tell you what to look for. IF the cage mates mess with the wound, it will be a larger wound to deal with. ****
Many people prefer to keep a wound dressed with an ointment until it heals. Some even use a wrap or gauze dressing for the wound. I do not do this because of the added stress to the glider, which delays healing.

At all times, wound management MUST be directed and supervised by a licensed and experienced veterinarian.

Antibiotics are essential for a wound healing through secondary intention. Additionally, it is very important that the glider's living environment be kept very clean during the healing time. Pain management should be considered for the first few days at a minimum. Beyond this, I allow the glider to dictate whether pain medication is necessary.

Because a wound healing by secondary intention heals from the inside-out, the wound is completely healed at the time the skin comes back together and heals fully. During the healing time, one will be able to see pink tissue that is granulated. This is good, healing tissue. Additionally, the edges of the wound will remain clean and continue to grow together. Discharge or discoloration would indicate an infection. It is very easy to spot an infection early on in a wound of this sort.

I recommend utilizing CONVENIA as an antibiotic for all healing wounds. It is easy to use as it is an injection given by the vet. It is less stressful than oral antibiotics and you are assured that the glider has received 100% of the dose.

-----------♥♥♥♥♥♥♥♥-----------
~*~ Val ~*~
Passionate = one step down from crazy

We can only be said to be alive in those moments when our hearts are conscious of our treasures - Thornton Wilder

We are what we are, no matter what we might wish to be, or pretend to be. - Dean Koontz in The Face

My favorite color is orange - I'm the normal one.


Last edited by Something_To_Believe_In on Mon Nov 15, 2010 11:44 pm; edited 1 time in total
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Chris R



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PostSubject: Re: Healing by primary intention OR by Secondary Intention   Sun Jan 03, 2010 2:18 pm

Val...I have a question for you on this topic as I have been extremely blessed and have never had an open wound to deal with in gliders (although I have just about every other species out there LOL)...but this is certainly something I need to know as I have breeders that are getting close to that 2-3 years stage where she might decide she doesnt want to breed anymore......

You said you dont do wound care (ointment etc) after the first week...but during the first week..are you doing a sort of debridement treatment to keep the wound open? Have you ever tried to do debridement to speed the healing in an especially deep wound and if so...what were the results?
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Something_To_Believe_In
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PostSubject: Re: Healing by primary intention OR by Secondary Intention   Sun Jan 03, 2010 7:58 pm

Yes, I have had to debride a few wounds. But, this has been rare given the number of wounds I have treated. Gliders are relatively clean and will keep the wound clean by themselves. It is amazing what they can do without irritating the wound, if you just give them the chance.

BUT, I have found that it does not take much to get a good result in gliders. Most of the time, my philosophy is "less is more." I use a sterile saline and a syringe with a needle. You can get a good stream and be very accurate with aiming it this way. That is pretty much all it takes.

I have not had but one wound even try to scab over. Even without the use of ointments and such. The one wound that scabbed over here resulted in a nasty scar where the fur will not grow back at all. Every other wound that I have had here has had fur grow back after the healing. I am interested to see if this will happen with Java once his wound is finally closed. He has had an open wound for 18 months!

Did I answer your question? I feel like I rambled.

-----------♥♥♥♥♥♥♥♥-----------
~*~ Val ~*~
Passionate = one step down from crazy

We can only be said to be alive in those moments when our hearts are conscious of our treasures - Thornton Wilder

We are what we are, no matter what we might wish to be, or pretend to be. - Dean Koontz in The Face

My favorite color is orange - I'm the normal one.
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Chris R



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Join date: 2009-12-23
Age: 45
Location: Northwestern Missouri

PostSubject: Re: Healing by primary intention OR by Secondary Intention   Sun Jan 03, 2010 8:11 pm

Yes you did..and the sterile saline through a small needle is a form of debridement....Its my prefernce to use when debriding also....

treated a cat that was a fan belt kitty....had to debride daily...on top of keeping the area moist with scarlet oil (love that stuff but not sure about using it on gliders)...this kitten was literally scalped from the shoulder blades to top of anus and 1/2 way down its sides....all the way to the vertebra.....all but a small section (less than 1 inch square) eventually grew hair back....

the granulated new tissue you refer to is also called proud flesh....debriding it helps it to keep growing, not to scab but also not to grow to much...does that make sense at all???
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