A farm labourer presents 4 hours after sustaining a heavily contaminated laceration of the forearm from an animal bite, with soil visible in the wound bed. After thorough debridement and irrigation, what is the most appropriate management of this wound?
- A Immediate primary closure with a subcuticular suture
- B Delayed primary closure after 3 to 5 days if the wound remains free of infection ✓
- C Leave the wound open permanently and allow healing by secondary intention
- D Immediate split-thickness skin graft coverage of the defect
Correct answer: B. Delayed primary closure after 3 to 5 days if the wound remains free of infection
Explanation
Heavily contaminated wounds should not be closed immediately because bacterial proliferation over 24 hours overwhelms host defenses and risks clostridial infection. Delayed primary closure at 3 to 5 days achieves the cosmetic benefit of primary closure once the wound is proven clean. Secondary intention leaves a larger scar and prolonged morbidity when the wound is suitable for later closure.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.