A farmhand presents 8 hours after a heavily contaminated puncture wound to the forearm with soil contamination and devitalised muscle. After thorough debridement and dressing, the wound looks clean and granulating on day 4. What is the appropriate closure strategy?

• A Leave it to heal by secondary intention
• B Primary closure with a Penrose drain
• C Immediate split-thickness skin grafting
• D Delayed primary closure now ✓

Explanation

Closing a contaminated wound after 3 to 5 days once it is visibly clean is delayed primary closure, or healing by tertiary intention. It combines the infection safety of open management with the speed and cosmesis of closure. Immediate skin grafting is unnecessary because the bed can be closed directly, and leaving it fully open sacrifices time and leaves a larger scar.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.