Guidelines recommend primary closure of wounds that are clean and have no signs of infection within six to 12 hours of the injury; one study suggests that suturing can be delayed for up to 18 hours. (1,2) Wounds to areas with an extensive vascular supply (e.g., head, face) may be closed up to 24 hours from the time of injury. Because of the high risk of infection, bite wounds are typically left open unless they are on the face and are potentially disfiguring. Bite wounds may be reevaluated after antibiotic treatment for delayed primary closure. (3)
A 1988 case series of 204 minor, noninfected suture repair wounds that did not involve nerves, blood vessels, tendons, or bones found significantly higher rates of healing for wounds closed up to 19 hours after injury compared with later closure (92% vs. 77%).(1) Scalp and facial wounds repaired later than 19 hours after injury had higher healing rates compared with wounds involving other body areas (96% vs. 66%).(1) There have been no RCTs comparing primary closure with delayed closure of nonbite traumatic wounds. (2)
1. Berk WA, Osbourne DD, Taylor DD. Evaluation of the ‘golden period’ for wound repair: 204 cases from a Third World emergency department. Ann Emerg Med. 1988;17(5):496–500
2. Eliya-Masamba MC, Banda GW. Primary closure versus delayed closure for non bite traumatic wounds within 24 hours post injury. Cochrane Database Syst Rev. 2013;(10):CD008574.
3. Fleisher GR. The management of bite wounds. N Engl J Med. 1999;340(2):138–140.