[Should traumatic wounds be closed within eight hours?]

It has been common practice in general medicine to refrain from primary closure of traumatic wounds that are more than six to eight hours old. It was thought that the primary closure of wounds later than this substantially increases the risk of infection. This time limit has its origin in old animal studies, and it is only in more recent decades that clinical studies have been conducted on unselected patients in general practice. The purpose of this article was to examine the scientific basis for this time limit.

A search was made in PubMed for clinical studies conducted on unselected patients with acute traumatic wounds treated with closure in general practice, including in accident and emergency departments, plus the time from the injury to primary closure versus the risk of infection.

The search yielded five clinical studies. These did not find that wounds must be closed within six to eight hours in order to avoid a greater risk of infection. They were all prospective observational studies from accident and emergency departments. The studies were heterogeneous, and all of them were of low research quality.

More recent clinical research does not define an absolute time limit of six to eight hours during which traumatic wounds can be closed without an increased risk of infection. Many wounds can presumably be closed later than this with no greater risk of infection. Good research-based guidelines will not be available until the results from robust randomised controlled studies have been published.