Early versus delayed closure of open fractures

The desired outcome in the management of Type III open injuries is not merely salvage but a limb which is functional, painless and aesthetically pleasing. The aim is to also achieve this outcome with the least number of reconstructive surgical procedures and minimal hospital stay. This is now possible by the emergence of many new concepts, by which primary closure is one. While the traditional expected standard of care was to leave the wound open and delay closure, the current evidence favours primary closure in open injuries if the following indications are met: (a) debridement performed within 12h, (b) no skin loss primarily or secondarily during debridement (Ganga Hospital Score [Russell GG, Henderson R, Arnett G. Primary or delayed closure for open tibial fractures. J Bone Joint Surg Br 1990;72:125-8]: score of '1' or '2'), (c) skin approximation possible without tension, (d) no farmyard of gutter contamination, (e) debridement performed to the satisfaction of the surgeon and (f) no vascular insufficiency.