Closure of wounds is divided into three major categories: closure by primary intent, closure by secondary intent, and closure by tertiary intent.

(1) Closure by primary intent. A wound which is repaired without delay after the injury is the definition of wound closure by primary intent. Such closure prevents the formation of granulation tissue and yields the fastest healing with the best cosmetic result. Closure by primary intent is the treatment of choice for a wound that is not infected or grossly contaminated. Closing the wound soon after the injury is important. The longer the time between injury and wound closure, the more bacteria can multiply.

Most lacerations should be closed within eight hours from the time of injury. If the patient is debilitated, has poor circulation, has laceration due to crushing injuries, or is grossly contaminated, wound closure should be performed within four hours.

(2) Closure by secondary intent. Here the wound is allowed to granulate on its own without surgical closure. The tissue is cleaned and dressed as usual, and the wound is covered with a sterile dressing. This is the procedure of choice for closing certain defects such as finger amputation and partial-thickness tissue loss. In the case of finger amputations, this type of closure usually gives better cosmetic and functional results.

(3) Closure by tertiary intent. This is delayed primary closure. The wound is initially cleaned and dressed as in secondary intent. The patient returns in three to four days for definitive closure. This is the procedure of choice for contaminated lacerations that would leave unacceptable scars if not closed. Examples of lacerations are mammalian bites, contaminated crush-lacerations, and cases when the patient delayed too long for treatment to close primarily.