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

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)