TY - CHAP M1 - Book, Section TI - Wound Closure A1 - Singer, Adam J. A1 - Hollander, Judd E. A2 - Tintinalli, Judith E. A2 - Ma, O. John A2 - Yealy, Donald M. A2 - Meckler, Garth D. A2 - Stapczynski, J. Stephan A2 - Cline, David M. A2 - Thomas, Stephen H. PY - 2020 T2 - Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e AB - The major goal of wound closure is to restore the skin’s integrity in order to reduce the risk of infection, scarring, and impaired function. Closure can occur in three ways. With primary closure, the wound is immediately closed by approximating its edges, with the main advantage being a reduction in healing time in comparison with other closure methods. Primary wound closure also may reduce bleeding and discomfort often associated with open wounds. Secondary wound closure, in which the wound is left open and allowed to close on its own, is particularly well suited for highly contaminated or infected wounds as well as in patients at high risk of infection. Although this method may reduce the risk of infection, it is relatively slow and uncomfortable and leaves a larger scar than primary closure. With delayed (or tertiary) closure, also sometimes referred to as delayed primary closure, the wound is initially cleansed and then packed with moist sterile gauze covered by a sterile covering. The dressing is left undisturbed unless signs of infection—fever, purulent exudate, or spreading cellulitis—develop. After 4 to 5 days, the dressing is removed, and the wound edges can be closed if no infection has supervened. This approach may be useful for highly contaminated wounds and animal bites, and while commonly described and recommended, there is little evidence documenting the effectiveness for traumatic wounds seen in the ED.1 SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accessmedicine.mhmedical.com/content.aspx?aid=1166530363 ER -