Wound healing is a key to all surgery, including even Beverly Hills plastic surgery. The next step up from secondary closure is primary closure. You can use sutures, staples, wound glue, and adhesive strips to close the edges of the wound directly and splint the wound in the position that will give the best cosmetic result. Primary closure is perfect for small neat wounds which are not infected, have a good blood supply, and are not under undue tension. You must remember that a wound heals despite sutures, rather than because of them, and that inappropriately placing sutures will rapidly lead to them breaking down.

If the wound is not suitable for direct primary closure, an alternative is delayed primary closure. This simply allows a period of secondary intention healing to progress to cause the wound to contract enough to let you close it directly. Vacuum assisted dressings may speed up healing (evidence is limited but increasing). Delayed primary closure is often used when it is not clear if the wound has been adequately prepared–for example, a non-contaminated wound with viable skin flaps or a wound with edges that you cannot quite get together. Wound healing occurs following all procedures, including liposuction.

What if, when assessing a wound, you find a large defect which is not amenable to primary closure, for which secondary closure is not suitable? If this defect is purely skin loss, with a healthy bed of tissue underneath–for example, an uncomplicated burn–then simply finding some way to replace the lost skin may be the best bet. A skin graft is an autologous (material is taken from one part of a patient to another anatomical site on the same patient) transplantation of skin, which in the process of transfer, is completely separated from its blood supply.

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