[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Tissue repair](https://durgical.com/en/general-pathology/#a-repair) › Healing of skin wounds: first and second intention

[General pathology](https://durgical.com/en/general-pathology/) · [Tissue repair](https://durgical.com/en/general-pathology/#a-repair)

# Healing of skin wounds: first and second intention

- Process

A clean cut with edges brought together heals fast with a thin scar; an open wound fills from the bottom up, shrinks and leaves a bigger scar.

Updated 2026-11-01

## Key points

- Phases: haemostasis → inflammation → proliferation (granulation tissue, re-epithelialisation) → remodelling.
- First intention: clean edges brought together, little granulation tissue, thin scar.
- Second intention: open wound, more inflammation and granulation tissue, contraction by myofibroblasts.
- Strength is about 10% at one week and about 70–80% at three months; it never reaches 100%.
- Dehiscence risk is highest in the first two postoperative weeks.

## What it is

Skin wounds heal in overlapping phases: haemostasis, inflammation, proliferation and remodelling. Healing by first (primary) intention happens when the edges are close, as in a sutured surgical incision. Healing by second (secondary) intention happens in large, open or infected wounds, which need more granulation tissue and contract. A third route, delayed primary closure, is used for contaminated wounds. The timeline explains when sutures come out and when a wound is weakest.

## Step by step

- First hours: the incision fills with clot; neutrophils reach the edges within 24 hours.
- 24–48 hours: basal epidermal cells from both edges migrate and proliferate, covering the cut with a thin epithelial layer.
- Day 3: macrophages replace neutrophils and granulation tissue begins to invade the incision space.
- Day 5: granulation tissue fills the gap; new vessel formation peaks and collagen fibrils begin to bridge the incision.
- Week 2: collagen keeps accumulating, vessels and oedema decrease, and the scar starts to blanch.
- End of month 1: a scar of collagen with few cells, covered by intact epidermis; hair follicles and glands along the line are lost.
- Following months: remodelling; strength rises from about 10% at suture removal to about 70–80% by three months.

## First vs second intention

| Feature | First intention | Second intention |
| --- | --- | --- |
| Typical wound | Clean surgical incision with edges brought together | Large, gaping, infected or ulcerated wound left open |
| Inflammation | Limited | More intense (more debris, fibrin, infection) |
| Granulation tissue | Little | Abundant; fills the defect from the base |
| Wound contraction | Minimal | Marked, by myofibroblasts |
| Scar | Thin line | Larger; may cause contracture |
| Time | Shorter | Longer |

## Clinical notes

- Delayed primary (tertiary) closure: a contaminated wound is left open for a few days, cleaned and then sutured.
- Wound dehiscence is most common in the first one to two weeks, when strength is lowest; risk rises with infection, obesity, coughing, vomiting, malnutrition and glucocorticoids.
- A healed wound never regains full strength, which is why incisional hernias can appear months or years later.

## Memory aid

First intention is a zip: the edges meet. Second intention is a pothole: it fills from the bottom and then the road shrinks.

## Test yourself

Think of the answer, then tap the question to see it.

## Which cells drive wound contraction in healing by second intention?

Myofibroblasts, fibroblasts with contractile filaments of alpha-smooth muscle actin.

## About how strong is a wound, compared with normal skin, when sutures are removed at one week?

About 10%; it reaches roughly 70–80% by three months and never returns to 100%.

## When is a surgical wound most likely to dehisce?

In the first one to two postoperative weeks, before enough collagen has been deposited and cross-linked.

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## Related

- [Granulation tissue and scar formation](https://durgical.com/en/general-pathology/granulation-tissue-and-scar-formation/)
- [What delays healing: infection, diabetes, nutrition, glucocorticoids, poor blood flow](https://durgical.com/en/general-pathology/what-delays-healing-infection-diabetes-nutrition-glucocorticoids-poor-blood-flow/)
- [Abnormal repair: chronic wounds, hypertrophic scar, keloid, contracture](https://durgical.com/en/general-pathology/abnormal-repair-chronic-wounds-hypertrophic-scar-keloid-contracture/)
- [Tissue repair: regeneration or scar; labile, stable and permanent cells](https://durgical.com/en/general-pathology/tissue-repair-regeneration-or-scar-labile-stable-and-permanent-cells/)

## Related conditions

- [Wound dehiscence and evisceration](https://durgical.com/en/conditions/wound-dehiscence-and-evisceration/)
- [Pressure injury (pressure ulcer)](https://durgical.com/en/conditions/pressure-injury/)
- [Burns (thermal, chemical, electrical; inhalation injury)](https://durgical.com/en/conditions/burns/)
- [Diabetic foot](https://durgical.com/en/conditions/diabetic-foot/)
- [Venous leg ulcer](https://durgical.com/en/conditions/venous-leg-ulcer/)
- [Incisional (ventral) hernia](https://durgical.com/en/conditions/incisional-hernia/)
- [Keloid and hypertrophic scar](https://durgical.com/en/conditions/keloid-and-hypertrophic-scar/)

## Elsewhere in DurgiPedia

- [Wound healing: phases and scar](https://durgical.com/en/histology/wound-healing-phases-and-scar/)
- [Skin: epidermis layers, dermis, hypodermis](https://durgical.com/en/histology/skin-epidermis-layers-dermis-hypodermis/)
- [Stem cells and tissue renewal: labile, stable and permanent tissues](https://durgical.com/en/histology/stem-cells-and-tissue-renewal-labile-stable-and-permanent-tissues/)
- [Hair follicles, sebaceous and sweat glands, nails](https://durgical.com/en/histology/hair-follicles-sebaceous-and-sweat-glands-nails/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [4.6 Tissue Injury and Aging](https://openstax.org/books/anatomy-and-physiology-2e/pages/4-6-tissue-injury-and-aging) (OpenStax (Anatomy and Physiology 2e), 2022); [Wounds and Injuries | Fracture | Bruises | MedlinePlus](https://medlineplus.gov/woundsandinjuries.html) (MedlinePlus, US National Library of Medicine, 2026); [Pressure Sores | Bedsores | Pressure Ulcers | MedlinePlus](https://medlineplus.gov/pressuresores.html) (MedlinePlus, US National Library of Medicine, 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/healing-of-skin-wounds-first-and-second-intention/