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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 2, 217-224.
doi: 10.1302/0301-620X.91B2.21228  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Immediate primary skin closure in type-III A and B open fractures

RESULTS AFTER A MINIMUM OF FIVE YEARS

S. Rajasekaran, MS, FRCS, PhD, Director and Head1; J. Dheenadhayalan, MS, Consultant Surgeon1; J. N. Babu, MS, FNB, Clinical Fellow1; S. R. Sundararajan, MS, Consultant Surgeon1; H. Venkatramani, MS, MCh, Consultant Surgeon2; and S. R. Sabapathy, MCh, DNB, FRCS, Director and Head2

1 Department of Orthopaedics, Traumatology and Spine
2 Department of Plastic, Hand and Reconstructive Surgery Ganga Hospital, 313 Mettupalayam Road, Coimbatore 641043, India.

Correspondence should be sent to Dr S. Rajasekaran; e-mail: sr{at}gangahospital.com

Between June 1999 and May 2003 we undertook direct primary closure of the skin wounds of 173 patients with Gustilo and Anderson grade-IIIA and grade-IIIB open fractures. These patients were selected from a consecutive group of 557 with type-III injuries presenting during this time. Strict criteria for inclusion in the study included debridement within 12 hours of injury, no sewage or organic contamination, no skin loss either primarily or secondarily during debridement, a Ganga Hospital open injury skin score of 1 or 2 with a total score of ten or less, the presence of bleeding skin margins, the ability to approximate wound edges without tension and the absence of peripheral vascular disease. In addition, patients with polytrauma were excluded.

At a mean follow-up of 6.2 years (5 to 7), the outcome was excellent in 150 (86.7%), good in 11 (6.4%) and poor in 12 (6.9%). A total of 33 complications occurred in 23 patients including superficial infection in 11, deep infection in five and the requirement for a secondary skin flap in three. Six patients developed nonunion requiring further surgery, one of whom declined additional measures to treat an established infected nonunion.

Immediate skin closure when performed selectively with the above indications proved to be a safe procedure.




eLetters:

Read all eLetters

Immediate primary skin closure in type-III A and B open fractures
Carlos A. M. F. Carvalho
J Bone Joint Surg Br Online, 5 Feb 2009 [Full text]
Immediate primary skin closure in type-III A and B fractures
Bolarinwa A. Akinola, et al.
J Bone Joint Surg Br Online, 27 Feb 2009 [Full text]
Classification of Gustilo grade IIIB fractures
Daniel J Rolton, et al.
J Bone Joint Surg Br Online, 6 Mar 2009 [Full text]
Role of Ganga Hospital Score in immediate primary skin closure in type-III A and B open fractures
VV NarayanaRao, et al.
J Bone Joint Surg Br Online, 17 Mar 2009 [Full text]
Primary skin closure of open fractures
Sharaf B Ibrahim FRCS MS Orth
J Bone Joint Surg Br Online, 2 Jul 2009 [Full text]

(c) British Editorial Society of Bone and Joint Surgery All Rights Reserved
Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General