Soft-tissue coverage in open fractures
Only ever after wound excisions are complete
Delayed closure of the traumatic wound is safer in all open fractures.
After wound débridement has been satisfactorily completed, in either one or more procedures, consideration must be given to the best means of wound coverage. Excessive skin tension will prevent wound healing. Furthermore, a contaminated wound is virtually certain to become infected with primary closure.
Temporary open wound management with delayed primary closure, or preferably split skin grafting, is the safest approach for the majority of open fractures. However, with low-energy fractures and benign wounds, immediate wound closure can be considered. If primary closure is chosen, the surgeon must watch carefully for signs of wound infection.
If closure is delayed, it should be completed as soon as it is safe to do so, in order to minimize the risk of secondary hospital infection.