The fourth and final phase of wound healing, remodeling/scar formation, typically lasts 12 months but can continue as long as 2 years after the initial injury.

A closed wound, on the other hand, is any injury in which underlying tissue has been damaged but the overlying skin is still intact.

[8] Fractures can be classified as either open or closed, depending on whether the integrity of the overlying skin has been disrupted or preserved, respectively.

Most commonly, these are wounds which develop due to an underlying disease process such as diabetes mellitus or arterial/venous insufficiency.

According to this classification system, four different classes of wound exist, each with their own postoperative risk of surgical site infection:[2][23] Wound presentation will vary greatly based on a number of factors, each of which is important to consider in order to establish a proper diagnosis and treatment plan.

[28] Irrigation can also be achieved with a diluted 1% povidone iodine solution, but studies have again shown no difference in infection rates when compared to normal saline.

Additionally, devitalized tissue creates a physical barrier over a wound which limits the effectiveness of any applied topical compounds and prevents re-epithelialization.

Debridement can be achieved in several ways:[30] The end goal of wound care is to re-establish the integrity of the skin, a structure which serves as a barrier to the external environment.

When healing by secondary intention, granulation tissue grows in from the wound edges slowly over time to restore integrity of the skin.

Healing by secondary intention can take up to months, requires daily wound care, and leaves an unfavorable scar, thus primary closure is always preferred when possible.

[27][35] As an alternative, wounds that cannot be closed primarily can be addressed with skin grafting or flap reconstruction, typically done by a plastic surgeon.

[33] There are several methods that can be implemented to achieve primary closure of a wound, including suture, staples, skin adhesive, and surgical strips.

[36] Staples are less time-consuming and more cost effective than suture but have a risk of worse scarring if left in place for too long.

[27] Adhesive glue and sutures have comparable cosmetic outcomes for minor lacerations <5 cm in adults and children.

Adhesive glue should not be used in areas of high tension or repetitive movements, such as joints or the posterior trunk.

[33][43] There is moderate evidence that honey is more effective than antiseptic followed by gauze for healing wounds infected after surgical operations.

[44] Therapeutic touch has been implicated as a complementary therapy in wound healing; however, there is no high quality research supporting its use as an evidence based clinical intervention.