Closure of wounds
Most wounds in open fractures are closed with delayed primary closure. Surgical incisions performed
during initial debridement can be closed primarily and original open fracture wound left open. Assisted
wound closure using antibiotic bead pouch or vacuum assisted dressings are useful methods.
Management of wounds in open fractures may necessitate early primary closure, split skin graft (SSG), fasciocuteneous flap, rotational muscle flap and free muscle flaps. Godina showed that wide early
experienced debridement to clearly healthy tissues and early rotational or free muscle flap cover may be
better in experienced hands than sequential debridement and delayed closure26. Early closure has shown
to prevent nosocomial infections common with multiple repeated debridements with delayed closure .
The aim should be to achieve closure in 72hours.