Prediction of healing time as an aid to the management of open granulating wounds

Abstract

The healing rates of 2 groups of patients were studied. Forty patients had laparotomy wounds that were left open to granulate because of overt or suspected infection, and 29 were from a series of pilonidal sinus excisions left unsutured as a matter of policy. The linear regressions of healing time against wound size were determined, the dimension chosen for wound size being either the breadth or depth, whichever was greater. From the results obtained, it was possible to calculate a “predicted” healing time for each wound corresponding to its size and to see how this differed from the observed time. The deviations found were used for statistical analysis relating to possible etiological factors; for example, the significance of infection as a cause of delayed healing. Prediction of the healing time for individual wounds allows the patient to be given information about the likely duration of wound healing. More importantly, it enables delay in wound healing to be recognized and investigated at an early stage and facilitates analysis of factors having a possible bearing on the process.

Development of an evidence‐based protocol for care of pilonidal sinus wounds healing by secondary intent using a modified reactive Delphi procedure. Part one: the literature review*

“…A formula to predict a 'normal' healing rate for pilonidal sinuses showed statistically significant longer healing times in wounds containing mixed aerobic and anaerobic bacteria (P = 0·005) (22,24,25). This was later used to substantiate the deleterious effect of heavy anaerobic load on healing in PSW (n = 150) (24).…”

“…Microbiology of infected pilonidal sinus wounds The PSW in the natal cleft may be contiguous or lie within a few centimetres of the anal verge, (22) and is often exposed to faecal material containing bacteroides (22) and body hairs, the follicles of which are normally inhabited by anaerobes and Gram-positive cocci, increasing risk for late secondary contamination and infections (23).…”

“…Those with recurrent disease healed at an average of 48 days, and three developed recurrent disease. Although lacking key information (wound size and bacteriological status), or an attempt to predict what the normal healing time for these wounds would have been (22), the difference in healing between obese and lean patients represents roughly 3 weeks longer healing for obese patients with a treatment that reputedly speeds the rate of healing. It may be that given sheer body size the wounds of the obese individuals were larger than those of their leaner colleagues, which would correlate to longer healing times regardless of the treatment.…”

Regional Variation in Wound Contraction of Mohs Surgery Defects Allowed to Heal by Second Intention

“…Since then, other authors have published additional data that firmly establish anatomic site (more specifically cosmetic subunit) as the most important consideration for predicting the final result of a secondarily healed wound 5–9 . Although SIH continues to gain acceptance as a valuable alternative to primary surgical repair, the majority of human studies have focused on time to heal, 10 infection rates, 11 types of dressings, 12 and subjective assessments of cosmetic acceptability as noted previously here. Little attention has been given to the amount of contraction occurring during the healing of a secondary intention wound in specific anatomic sites or the contribution wound contraction may have on the final cosmetic result.…”

Modelling the cost implications of using carboxymethylcellulose dressing compared with gauze in the management of surgical wounds healing by secondary intention in the US and UK

“…However, healing is affected by intrinsic and extrinsic factors that may result in complications. For example, wound healing can be delayed due to the presence of infection, wound dehiscence or the presence of foreign material 5,6 . This can result in wounds becoming cavities, necessitating healing by secondary intention 7 .…”