Primary closure versus delayed closure for non bite traumatic wounds within 24 hours post injury

Abstract

Background: Acute traumatic wounds are one of the common reasons why people present to the emergency department. Primary closure has traditionally been reserved for traumatic wounds presenting within six hours of injury and considered 'clean' by the attending surgeon, with the rest undergoing delayed primary closure as a means of controlling wound infection. Primary closure has the potential benefit of rapid wound healing but poses the potential threat of increased wound infection. There is currently no evidence to guide clinical decision-making on the best timing for closure of traumatic wounds.

Objectives: To determine the effect on time to healing of primary closure versus delayed closure for non bite traumatic wounds presenting within 24 hours post injury. To explore the adverse effects of primary closure compared with delayed closure for non bite traumatic wounds presenting within 24 hours post injury.

Search strategy: We searched the Cochrane Wounds Group Specialised Register (searched 14 July 2011); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3); Ovid MEDLINE (1950 to July Week 1 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, July 13, 2011); Ovid EMBASE (1980 to 2011 Week 27); and EBSCO CINAHL (1982 to 14 July 2011). There were no restrictions with respect to language, date of publication or study setting.

Selection criteria: Randomised controlled trials comparing primary closure with delayed closure of non bite traumatic wounds.

Data collection and analysis: Two review authors independently evaluated the results of the searches against the inclusion criteria. No studies met the inclusion criteria for this review.

Main results: Since no studies met the inclusion criteria, neither a meta-analysis nor a narrative description of studies was possible.

Authors' conclusions: There is currently no systematic evidence to guide clinical decision-making regarding the timing for closure of traumatic wounds. There is a need for robust research to investigate the effect of primary closure compared with delayed closure for non bite traumatic wounds presenting within 24 hours of injury.