Closure

Goal: In most cases, war wounds should be closed by a surgical facility, where infection can be more effectively mitigated and the wound can be explored more effectively. However, when appropriate, wound closure simplifies the overall management of the wound.

- Puncture wounds, in general, should not be primarily closed. Small wounds should be allowed to freely drain as needed and close by secondary intent. Larger puncture wounds may require debridement and irrigation, as described above.
- Lacerations with minimal tissue loss/destruction and minimal need for debridement can generally be primarily closed provided that the wound is clean, there is not significant tension with the closure, and there has been <12 hours from injury to closure (this can be extended to 24 hours for lacerations to the face or scalp).
- Lacerations that do not meet the above criteria can be considered for a DPC. These patients are provided 3–7 days of wound care to assure the wound is clean and without complications, and then is closed with either widely spaced sutures or staples.
- Undermine wound margins if needed to reverse the retracted and inverted edges, and relieve any tension to allow skin closure.
- Wounds with tissue loss or damage are generally not closed primarily. Instead, these wounds are treated with dressing changes and allowed to heal by secondary intent. However, there is occasionally a role for DPC in select wounds.
- When in doubt, it is better to leave a wound open and plan for healing by secondary intent.
- If a wound becomes infected after closure, it should be reopened and debrided to drain pus and remove infected, dead tissue.

Caution: Wound closure may speed healing; however, closure will also greatly increase the risk of infection. Only wounds that are very clean and have been well-debrided should be closed.