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

Abstract

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.