Evaluation of the 'golden period' for wound repair: 204 cases from a Third World emergency department.

Uncertainty about the existence and duration of a "golden period" for suture repair of simple wounds led us to evaluate prospectively the consequences of delayed primary closure on wound healing. Wounds were eligible for study if they were not grossly infected, and had no associated injuries to nerves, blood vessels, tendons, or bone. Three hundred seventy-two patients underwent suture repair; 204 (54.8%) returned for review seven days later. The mean time from wounding to repair for all patients was 24.2 +/- 18.8 hours. Wounds closed at up to 19 hours after wounding had a significantly higher rate of healing than those closed later: 82 of 89 (92.1%) compared with 89 of 115 (77.4%) (P less than .01). Of 23 wounds sutured 48 or more hours (mean, 65.3) after wounding, 18 (78.3%) were healing at follow-up. In contrast to wounds involving other body areas, the healing of head wounds was virtually independent of time from injury to repair: 42 of 44 (95.5%) wounds involving the head and repaired later than 19 hours after injury were healing, compared with 47 of 71 (66.2%) of all other wounds (P less than .001). On the basis of these data we conclude that there is a 19-hour "golden period" for repair of simple wounds involving body areas other than the head, after which sutured wounds are significantly less likely to heal, and the healing of clean, simple wounds involving the head is unaffected by the interval between injury and repair.

Evaluation of the "golden period" for wound repair: 204 cases from a third world emergency department

Uncertainty about the existence and duration of a "golden period" for suture repair of simple wounds led us to evaluate prospectively the consequences of delayed primary closure on wound healing. Wounds were eligible for study if they were not grossly infected, and had no associated injuries to nerves, blood vessels, tendons, or bone. Three hundred seventy-two patients underwent suture repair; 204 (54.8 percent) returned for review seven days later. The mean time from wounding to repair for all patients was 24.2ñ18.8 hours. Wounds closed at up to 19 hours after wounding had a significantly higher rate of healing than those closed later: 82 of 89 (92.1 percent) compared with 89 of 115 (77.4 percent) (P less than .01). Of 23 wounds sutured 48 or more hours (mean, 65.3) after wounding, 18 (78.3 percent) were healing at follow-up. In contrast to wounds involving other body areas, the healing of head wounds was virtually independent of time from injury repair: 42 of 44 (95.5 percent) wounds involving the head and repaired later than 19 hours after injury were healing, compared with 47 of 71 (66.2 percent) of all other wounds (P less than .001). On the basis of these data we conclude that there is a 19-hour "golden period" for repair of simple wounds involving body areas other than the head, after which sutured wounds are significantly less likely to heal, and the healing of clean, simple wounds involving the head is unaffected by the interval between injury and repair. (AU)

The effect of late primary repair on healing of simple wounds: analysis of 207 cases - abstract

Although orthodox doctrines of wound care dictate that wounds presenting after a "golden period" of six to 24 hours should be managed with delayed closure, the large number of late presenting wound seen in the Casualty Department, Kingston Public Hospital, makes delayed management problematic. We therefore decided to study, prospectively, the consequences of delayed mangement problematic. We therefore decided to study, prospectively, the consequences of delayed primary closure on wound healing. All wounds seen by the authors between June and September, 1986 were considered eligible for inclusion if (1) they were not grossly infected, (2) there were no associated injuries to structures such as nerves, blood vessels and tendons, and (3) the patients were capable of relating the time of wounding and returning for follow-up. Shortages of sterile equipment necessitated closure of up to eight wounds with each suture set and pair of sterile gloves. Four hundred and sixty-eight patients underwent suture repair; two hundred and seven (44.2 percent) returned for review. The results are summarized as follows: HOURS; - 0-6, 7-12, 13-24, 25-48, >48; (MEAN) - (4.4), (9.3), (20.2), (32.3), (63.8) respectively; SUTURED; - 28, 47, 65, 47, 20 respectively; HEALING; 25, 45 51, 35, 15 respectively; percentHEALING - 89.3, 95.7, 78.5, 74.4, 75.0 respectively. ALL: (22.5), 207, 171, 82.6 respectively. When patients were considered according to whether repair was performed within 22 hours or later, the following was found: HOURS -<22, >22; (M) - (10.3), (35.6) respectively; SUTURED - 107, 100 respectively, HEALING - 98, 73 respectively; percent HEALING - 91.6, 73.0 respectively. The difference in healing between these two groups is significant at the p<0.001 level. We conclude that, although wounds sutured within 22 hours after injury have a significantly greater chance of healing than those repaired later, this advatage is relative, not absolute. The success experienced when suturing was performed more than 48 hours after injury indicates that primary repair is a practical, safe way of managing uncomplicated, late presenting wounds (AU)