Secondary Closure of Wounds
In the Naval Hospital at Auckland, New Zealand, the most common operation was the secondary closure of wounds. The majority of the wounded evacuated through this hospital from the Guadalcanal and New Georgia campaigns had open wounds when they arrived. Convalescence was often materially shortened and disability minimized by closing these wounds. I believe that the same principles can well be applied to wounds and injuries seen in civilian practice.
INDICATIONS FOR SECONDARY CLOSURE
The rate of healing of wounds varies greatly and does not appear to be related either to gross infection or to vitamin C deficiency. Moreover, the factors which influence the rapidity with which a wound closes of its own accord have not been determined.
Wounds close by contraction and by epithelization. These processes proceed at different speeds in different persons and in wounds of the same size in different locations. Wounds of the leg, particularly over the tibia, and wounds about the hip usually close slowly. An underlying bone, such as the tibia, seemingly interferes with contraction and with the blood supply necessary for growth of epithelium. Difficulty in immobilizing the hip without using a body cast may be responsible for failure of wounds about the hip to heal.
The size of a wound does not necessarily determine the advisability of closing it. In general, a wound over 2 inches in diameter should be closed, although occasionally it contracts and epi helizes so fast that spontaneous healing is nearly as rapid as the development of solid. . .