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    Patent Pending

    Wound Closure Classification

    Classifies types of wound closure.
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    INSTRUCTIONS

    Use in patients with open wounds, with a focus on wounds resulting from trauma.

    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with open wounds after traumatic injuries. The types of wound closure will differ depending on the wound’s etiology and pattern of injury, morphology, contamination classification, and complexity.

    • The types of wound closure are clearly described; however, patient-specific characteristics, such as risk factors and nutritional status, in addition to the quality of the wound itself, will make every clinical scenario different.
    • Surgeon experience and judgment often dictate type and timing of closure.
    • Has limited application in abdominal and orthopedic wounds. Multiple studies (of varying levels of evidence) have compared primary versus delayed primary closure of contaminated or infected abdominal wounds, and of traumatic open orthopedic wounds, in the context of reducing surgical site infections— currently no definitive evidence-based consensus exists on the optimal time of primary skin closure for either abdominal or orthopedic wounds.

    The type and timing of wound closure in traumatic or contaminated wounds play a role in the incidence of surgical site infections. Surgical site infections are a source of significant morbidity to the patient and increased health care costs.

    Clean wounds with minimal tissue loss, e.g. surgical wounds, clean lacerations
    Significant tissue loss precluding tension-free approximation of edges, devitalized edges, ulcerations, or abscess cavities
    Grossly contaminated wounds with or without significant tissue loss

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Management will depend on the diagnosed pathology or injury, and wound closure will differ depending on the clinical scenario.
    • Surgeon experience and judgment will generally dictate the type and timing of closure. Multiple studies of varying levels of evidence have compared primary versus delayed primary closure of contaminated or infected abdominal wounds in the context of reducing surgical site infections, with no definite conclusions.

    Management

    • For the management of open fractures, ACS TQIP guidelines, which are based on expert opinion due to lack of evidence, recommend that skin defects overlying open fractures should be closed at the time of initial debridement.
    • For open fractures associated with wounds requiring coverage with skin grafting or soft tissue transfers (in other words, Gustilo type IIIB), it is recommended that coverage be completed within seven days from the time of the injury.
    Content Contributors
    • Jennie Kim, MD
    Reviewed By
    • Ronald Simon, MD, FACS
    About the Creator
    Dr. David Leaper
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    Content Contributors
    • Jennie Kim, MD
    Reviewed By
    • Ronald Simon, MD, FACS