From the Research
Suture repair of lacerations greater than 6 hours old should be approached with caution, and delayed primary closure is recommended for contaminated wounds, as it has been associated with lower rates of surgical site infections and superior mechanical strength, as shown in a recent study 1. When considering suture repair for lacerations greater than 6 hours old, it is essential to weigh the risks of infection against the potential benefits of primary closure.
Key Considerations
- Thorough wound cleansing, including irrigation with normal saline or dilute povidone-iodine solution, and meticulous debridement of devitalized tissue, is crucial before closure.
- Antibiotic prophylaxis should be considered, particularly for high-risk wounds, with options including amoxicillin-clavulanate or alternative antibiotics for penicillin-allergic patients.
- The wound should be closed in layers using appropriate suture material, such as absorbable sutures for deep layers and non-absorbable sutures for skin closure.
- Tetanus prophylaxis must be administered if the patient's immunization status is incomplete or unknown.
Delayed Primary Closure
Delayed primary closure, as described in a 2023 study 1, involves mechanically closing a wound after several days of secondary intention healing and may be beneficial in contaminated wounds, such as those resulting from complicated appendectomies or postcardiac surgery.
Recommendations
- For contaminated wounds, delayed primary closure is recommended, with the wound dressed in saline/betadine soaks, changed and irrigated daily, and delayed closure lasting between 3 and 5 days or until the infection has resolved 1.
- Suture removal timing varies by location, with facial wounds typically requiring removal after 3-5 days, trunk wounds after 7-10 days, and extremity wounds after 10-14 days.
- Heavily contaminated wounds, puncture wounds, or those with significant tissue loss may be better managed with delayed primary closure or healing by secondary intention to minimize infection risk. It is essential to note that the decision to perform primary closure or delayed primary closure should be made on a case-by-case basis, taking into account the individual patient's risk factors and the specific characteristics of the wound, as there is currently no systematic evidence to guide clinical decision-making regarding the timing for closure of traumatic wounds 2.