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Healing by Secondary Intention

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1. Negative pressure wound therapy for wounds healing by secondary intention

Negative pressure wound therapy for wounds healing by secondary intention 1 Translation of Chapters 1 to 6 of the final report Vakuumversiegelungstherapie von Wunden mit intendierter sekundärer Wundheilung (Version 1.1; Status: 25 June 2019 [German original] / 20 September 2019 [English translation]). Please note: This document was translated by an external translator and is provided as a service by IQWiG to English-language readers. However, solely the German original text is absolutely (...) authoritative and legally binding. Extract IQWiG Reports – Commission No. N17-01A Negative pressure wound therapy for wounds healing by secondary intention 1 Extract of final report N17-01A Version 1.1 Negative pressure wound therapy – wounds healing by secondary intention 25 June 2019 Institute for Quality and Efficiency in Health Care (IQWiG) - i - Publishing details Publisher: Institute for Quality and Efficiency in Health Care Topic: Negative pressure wound therapy for wounds healing by secondary

2019 Institute for Quality and Efficiency in Healthcare (IQWiG)

2. Antibiotics and antiseptics for surgical wounds healing by secondary intention. (PubMed)

Antibiotics and antiseptics for surgical wounds healing by secondary intention. Following surgery, incisions are usually closed by fixing the edges together with sutures (stitches), staples, adhesives (glue) or clips. This process helps the cut edges heal together and is called 'healing by primary intention'. However, a minority of surgical wounds are not closed in this way. Where the risk of infection is high or there has been significant loss of tissue, wounds may be left open to heal (...) by the growth of new tissue rather than by primary closure; this is known as 'healing by secondary intention'. There is a risk of infection in open wounds, which may impact on wound healing, and antiseptic or antibiotic treatments may be used with the aim of preventing or treating such infections. This review is one of a suite of Cochrane reviews investigating the evidence on antiseptics and antibiotics in different types of wounds. It aims to present current evidence related to the use of antiseptics

2016 Cochrane

3. Negative pressure wound therapy for wounds healing by primary intention

and Efficiency in Health Care (IQWiG) - iv - Key statement Research question The objective of this investigation is to ? assess the benefit of negative pressure wound therapy (NPWT) in comparison with standard wound therapy in patients with wounds healing by primary intention with regard to patient-relevant outcomes. The benefit assessment of NPWT in patients with wounds healing by secondary intention was conducted as part of project N17-01A. Conclusion A total of 45 studies supplied usable results (...) : Study pool of the benefit assessment – wounds healing by secondary intention (n = 67) 9 Table 3: Studies considered for calculating the data gap 13 Table 4: Matrix of patient-relevant outcomes 15 Table 5: Evidence map for patient-relevant outcomes 24 Extract of final report N17-01B Version 1.0 Negative pressure wound therapy – wounds healing by primary intention 12 June 2019 Institute for Quality and Efficiency in Health Care (IQWiG) - viii - List of abbreviations Abbreviation Meaning ACT

2019 Institute for Quality and Efficiency in Healthcare (IQWiG)

4. Negative pressure wound therapy for treating surgical wounds healing by secondary intention. (PubMed)

Negative pressure wound therapy for treating surgical wounds healing by secondary intention. Following surgery, incisions are usually closed by fixing the edges together with sutures (stitches), staples, adhesive glue or clips. This process helps the cut edges heal together and is called 'healing by primary intention'. However, not all incised wounds are closed in this way: where there is high risk of infection, or when there has been significant tissue loss, wounds may be left open to heal (...) from the 'bottom up'. This delayed healing is known as 'healing by secondary intention'. Negative pressure wound therapy (NPWT) is one treatment option for surgical wounds that are healing by secondary intention.To assess the effects of negative pressure wound therapy (NPWT) on the healing of surgical wounds healing by secondary intention (SWHSI) in any care setting.For this review, in May 2015 we searched the following databases: the Cochrane Wounds Group Specialised Register; The Cochrane Central

2015 Cochrane

5. Comparing the influence of two immunosuppressants (fingolimod, azathioprine) on wound healing in a rat model of primary and secondary intention wound closure. (PubMed)

Comparing the influence of two immunosuppressants (fingolimod, azathioprine) on wound healing in a rat model of primary and secondary intention wound closure. In this study, rat models of wound closure by first and second intention were developed to evaluate the influence that two immunosuppressants for treating multiple sclerosis (fingolimod, azathioprine) have on wound healing. Sixty-three Sprague-Dawley rats were daily treated with fingolimod (0.6 mg/kg), azathioprine (2.5 mg/kg), or placebo (...) (saline). Following 6 weeks of treatment, a linear incision (1.5 cm) or a circular excisional defect (diameter 1.5 cm) was made on the dorsal skin. The treatments were uninterrupted and after 7 days (incisional) or 21 days (incisional, excisional), animals were euthanized (n = 7 per group and time-point). Morphometric (wound closure), histological (stainings), and immunofluorescent studies (macrophages) were performed to evaluate the healing process. For both the incisional and excisional defects

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2018 Wound Repair and Regeneration

6. Patients’ perceptions and experiences of living with a surgical wound healing by secondary intention: A qualitative study (PubMed)

Patients’ perceptions and experiences of living with a surgical wound healing by secondary intention: A qualitative study Most surgical wounds heal by primary intention, that is to say, the edges of the wound are brought together with sutures, staples, adhesive glue or clips. However, some wounds may be left open to heal (if there is a risk of infection, or if there has been significant tissue loss), and are known as 'surgical wounds healing by secondary intention'. They are estimated (...) populations.Participants were aged 18 years or older and had at least one surgical wound healing by secondary intention, which was slow to heal. Purposeful sampling was used to include patients of different gender, age, wound duration and type of surgery (general, vascular and orthopaedic). Twenty people were interviewed between January and July 2012.Semi-structured interviews were conducted, guided by use of a topic guide developed with input from patient advisors. Data were thematically analysed using steps integral

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2018 International journal of nursing studies

7. Aloe barbadensis miller versus silver sulfadiazine creams for wound healing by secondary intention in dogs and cats: A randomized controlled study. (PubMed)

Aloe barbadensis miller versus silver sulfadiazine creams for wound healing by secondary intention in dogs and cats: A randomized controlled study. The objective of this study was to compare the effectiveness of the topical application of Aloe barbadensis Miller (juice and fresh gel) to skin wounds, in dogs and cats, with that of topically applied silver sulfadiazine cream. The sample included 16 patients with cutaneous wounds (13 dogs and three cats) that were divided into three groups. Aloe (...) vera "juice" and "fresh gel" were applied for groups I and II, respectively, while silver sulfadiazine was applied for the control group III. In order to evaluate the healing of wounds, the following parameters were taken into consideration: the percentage of wound shrinkage, the healing time and the macroscopic appearance of the scarring process. The interpretation of the data relating to the percentage of wound shrinkage showed a faster rate for groups I and II compared to that of group III

2018 Research in veterinary science Controlled trial quality: uncertain

8. Pilot feasibility randomized clinical trial of negative‐pressure wound therapy versus usual care in patients with surgical wounds healing by secondary intention (PubMed)

Pilot feasibility randomized clinical trial of negative‐pressure wound therapy versus usual care in patients with surgical wounds healing by secondary intention Surgical wounds healing by secondary intention (SWHSI) are increasingly being treated with negative-pressure wound therapy (NPWT) despite a lack of high-quality research evidence regarding its clinical and cost-effectiveness. This pilot feasibility RCT aimed to assess the methods for and feasibility of conducting a future definitive (...) RCT of NPWT for the treatment of SWHSI.Eligible consenting adult patients receiving care at the study sites (2 acute and 1 community) and with a SWHSI appropriate for NPWT or wound dressing treatment were randomized 1 : 1 centrally to receive NPWT or usual care (no NPWT). Participants were followed up every 1-2 weeks for 3 months. Feasibility (recruitment rate, time to intervention delivery) and clinical (time to wound healing) outcomes were assessed.A total of 248 participants were screened

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2018 BJS Open Controlled trial quality: uncertain

10. A survey of patients with surgical wounds healing by secondary intention; an assessment of prevalence, aetiology, duration and management (PubMed)

A survey of patients with surgical wounds healing by secondary intention; an assessment of prevalence, aetiology, duration and management Surgical wounds healing by secondary intention (SWHSI) are often difficult and costly to treat. There is a dearth of clinical and research information regarding SWHSI. The aim of this survey was to estimate the prevalence of SWHSI and to characterise the aetiology, duration and management of these wounds.Anonymised data were collected from patients with SWHSI (...) and the median duration of wounds was 28.0 (95% CI = 21 to 35) days. The most common surgical specialities associated with SWHSI were colorectal (80/187, 42.8%), plastics (24/187, 12.8%) and vascular (22/187, 11.8%) surgery. Nearly half of SWHSI were planned to heal by secondary intention (90/187, 48.1%) and 77/187 (41.2%) were wounds that had dehisced. Dressings were the most common single treatment for SWHSI, received by 169/181 (93.4%) patients. Eleven (6.1%) patients were receiving negative pressure

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2017 Journal of tissue viability

11. Case of Pleomorphic Dermal Sarcoma of the Eyelid Treated with Micrographic Surgery and Secondary Intention Healing (PubMed)

Case of Pleomorphic Dermal Sarcoma of the Eyelid Treated with Micrographic Surgery and Secondary Intention Healing Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal neoplasm sharing histopathological features with atypical fibroxanthoma (AFX), but has additional features of deep invasion of the superficial subcutis, tumor necrosis and vascular/perineural invasion. It is not well documented in the literature because of its rarity, and its clinical course has been debated due to the lack (...) was confirmed. Considering the conservation of the periocular function and the advanced age of the patient, we planned secondary intention healing rather than primary suturing. After surgery, skeletal muscle infiltration was found and the diagnosis was revised to PDS by a pathologist based on the currently accepted criteria for PDS. There has been no evidence of recurrence or periocular functional defects during a 2-year follow-up without adjuvant therapy. Although the PDS is highly malignant, complete

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2016 Annals of dermatology

12. Broader Practice Indications for Mohs Surgical Defect Healing by Secondary Intention: A Survey Study. (PubMed)

Broader Practice Indications for Mohs Surgical Defect Healing by Secondary Intention: A Survey Study. Recent reports have indicated secondary intention (SI) healing utilization for Mohs surgical defects beyond conventionally accepted indications.To characterize potentially more expansive guidelines for when SI healing is indicated or appropriate in dermatologic surgery.A survey study was e-mailed to the American College of Mohs Surgery in 2015. A group of 293 respondents addressed factors (...) influencing decisions to heal surgical defects secondarily.The most experienced surgeons were significantly more likely to heal deep and larger wounds secondarily. Many surgeons elect SI healing in patients with current or previous wound dehiscence, flap necrosis, or infection; in patients who have undergone skin cancer excisions before, or who are elderly, and; if the lesion was sent for permanent section, or when treating high-risk, large, recurrent, or aggressive tumors.Broader indications for SI

2016 Dermatologic Surgery

13. Antiseptics and Antibiotics for Surgical Wounds Healing by Secondary Intention: Summary of a Cochrane Review. (PubMed)

Antiseptics and Antibiotics for Surgical Wounds Healing by Secondary Intention: Summary of a Cochrane Review. Do antiseptics and antibiotics benefit surgical wounds healing by secondary intention (SWHSI)?No high-quality randomized clinical trials have addressed this question. Current evidence is limited and insufficient; it is uncertain whether treating SWHSI with antiseptics or antibiotics is beneficial.

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2016 JAMA dermatology (Chicago, Ill.)

14. A selected reaction monitoring based analysis of acute phase proteins in interstitial fluids from experimental equine wounds healing by secondary intention. (PubMed)

A selected reaction monitoring based analysis of acute phase proteins in interstitial fluids from experimental equine wounds healing by secondary intention. In horses, pathological healing with formation of exuberant granulation tissue (EGT) is a particular problem in limb wounds, whereas body wounds tend to heal without complications. Chronic inflammation has been proposed to be central to the pathogenesis of EGT. This study aimed to investigate levels of inflammatory acute phase proteins (...) pore microdialysis from experimental body and limb wounds from five horses at days 1, 2, 7, and 14 after wounding and healing without (body) and with (limb) the formation of EGT. The QconCAT included proteotypic peptides representing each of the protein targets and was used to direct the design of a gene, which was expressed in Escherichia coli in a media supplemented with stable isotopes for metabolically labeling of standard peptides. Co-analysis of wound interstitial fluid samples

2016 Wound Repair and Regeneration

15. Healing by Secondary Intention

Healing by Secondary Intention Healing by Secondary Intention Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Healing by Secondary (...) Intention Healing by Secondary Intention Aka: Healing by Secondary Intention , Secondary Healing From Related Chapters II. Indications Prolonged delay between and treatment See Minor soft tissue amputations without bone loss Less than 1 cm square in size No significant volar pulp loss If unsure Temporize with management below Arrange follow-up and possible graft in 1-2 days III. Management Cleansing Debridement Healing by Secondary Intention Dressing Changes Twice daily for 2 days after injury

2018 FP Notebook

16. Defining the Role of Secondary Intention Healing in Full-Thickness Lid Margin Defects. (PubMed)

Defining the Role of Secondary Intention Healing in Full-Thickness Lid Margin Defects. More than 30 years have passed since the first case series was published regarding the phenomenon of secondary intention healing in relation to lid margin defects. Despite the fascinating results, the technique has not gained widespread support. This study looks at a series of 34 marginal lower lid defects allowed to heal without intervention. The results are remarkable for their consistently high quality (...) , in terms of both cosmetic and functional outcomes. Medial lid defects, in particular, yielded results that would be difficult to surpass by conventional reconstructive techniques. The evidence presented here shows that secondary intention healing in lid margin defects should be considered as a genuine alternative to formal reconstruction, challenging the established dogma of bilamellar repair. For certain lid defects it is quite possibly (and unexpectedly) the new treatment of choice.Therapeutic, IV.

2016 Plastic and reconstructive surgery

17. Negative pressure wound therapy versus usual care for Surgical Wounds Healing by Secondary Intention (SWHSI trial): study protocol for a randomised controlled pilot trial. (PubMed)

Negative pressure wound therapy versus usual care for Surgical Wounds Healing by Secondary Intention (SWHSI trial): study protocol for a randomised controlled pilot trial. Most incisions following surgery heal by primary intention, with the edges of the wound apposed with sutures or clips. However, some wounds may break open or be left to heal from the bottom up (i.e. healing by secondary intention). Surgical Wounds Healing by Secondary Intention (SWHSI) are often more complex to manage (...) , and require additional treatments during the course of healing. There is significant uncertainty regarding the best treatment for these complex wounds, with limited robust evidence regarding the clinical and cost-effectiveness of different dressings and treatments; one such treatment is Negative Pressure Wound Therapy (NPWT) which is frequently used in the management of SWHSI. Previous randomised controlled trials (RCTs) of NPWT have failed to recruit to time and target, thus we aimed to conduct a pilot

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2016 Trials Controlled trial quality: uncertain

18. Second intention healing of nasal ala and dorsum defects in Asians. (PubMed)

and complete healing. Materials and methods: Fifteen defects (<1 cm in diameter) of the nasal ala and dorsum in 10 patients were allowed to heal by secondary intention. Cosmetic results were evaluated and the time to epithelialization and complete healing were recorded. Results: Cosmetic outcomes were good to excellent in 80% of the defects; defects of the dorsum showed poorer cosmetic results than defects of the ala. The wounds needed 5-17 days (mean 11.3; SD ± 4.18) to complete epithelialization and 10 (...) Second intention healing of nasal ala and dorsum defects in Asians. Background: Reconstruction of defects of nasal ala and dorsum after surgical excision presents a substantial challenge to dermatologic surgeons. Second intention healing is a simple and extremely useful method to optimize cosmesis after skin cancer removal. Objectives: This study reported the cosmetic outcomes after second intention healing of nasal ala and dorsum defects in Asians, and estimated the time to epithelialization

2019 Journal of Dermatological Treatment

19. Application of secondary intention for the restoration of the apical triangle after Mohs micrographic surgery. (PubMed)

Application of secondary intention for the restoration of the apical triangle after Mohs micrographic surgery. Background: Restoring the apical triangle (AT) to maintain the symmetry of the face after Mohs micrographic surgery can be challenging. We have applied secondary intention (SI) after partial closure in cases with large defects. Objective: To compare the cosmetic results between immediate closure (IC) and SI. Methods & Materials: We retrospectively reviewed 24 patients (IC group: n = 15 (...) in predicting the results of SI healing. The average visual analog scale score evaluated by two dermatologists was higher in the IC group, albeit without a significant difference (8.23 ± 0.96 vs. 7.78 ± 1.52, p = .5267). Conclusion: SI after partial closure can be an option for large defects in the AT area.

2019 Journal of Dermatological Treatment

20. Hidradenitis suppurativa treated with wide excision and second intention healing: A meaningful local cure rate after 253 procedures. (PubMed)

of an anatomical area was achieved in 49% of the procedures, whereas natural disease progression occurred in 13%. The genital region was the most prone to recurrence. The majority of the patients were glad that they had undergone the procedure and would recommend the surgical procedure to other HS patients.Lesional wide excision (complete excision) with secondary intention healing yields a meaningful local cure rate for HS and is well tolerated.© 2017 European Academy of Dermatology and Venereology. (...) Hidradenitis suppurativa treated with wide excision and second intention healing: A meaningful local cure rate after 253 procedures. Surgery is an important treatment modality for hidradenitis suppurativa (HS). Various methods of HS surgery have been described. Even though wide excision is a common surgical procedure for HS, data on the recurrence rate and patient satisfaction are scarce.To determine the recurrence rate and patient satisfaction of HS lesional wide excision (complete excision

2017 Journal of the European Academy of Dermatology and Venereology

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