Normal wound healing is sometimes called healing by first intention. Normally the tissues come together and heal completely within 21 days following surgical incisions or clean lacerations. Wounds that are jagged, infected, or have a large amount of tissue missing heal by secondary attention. This healing takes place from the bottom of the incision and proceeds at a much slower pace. If the wound is infected or necrotic, it may have to be debrided. Debridement is the surgical removal of necrotic tissue. Wounds will not heal unless this tissue is removed.
The major complication of wound healing is infection at the site of surgery. The patient should be given written instructions on the care of the wound and signs and symptoms of infection and instructed to call immediately with any concerns. The instructions should include how to care for the wound and how often to change the dressing or whether open-wound healing is an option for the patient. Be sure to document the instructions that you give the patient and his response to the instructions. If the wound or the wound care is extensive or the patient is unable to manage due to other health problems, you must make sure that there is a family member or outpatient health care provider to refer the patient to for help with dressing care. If a family member is involved, you must make sure that he or she is instructed. This also must be documented in the patient chart. The patient must also be given a time to return to the office to have the wound checked or to have sutures removed.