Research Article| Volume 2, ISSUE 1, P51-54, July 1970

Delayed primary operation for open injuries of the extremities, especially the hand (two-stage treatment)

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      A two-stage method of treatment of open injuries of the extremities is described consisting of primary surgical toilet of the skin and excision of the wound, leaving the wound itself open and covered with a dressing moistened with 0·005 per cent cetrimide. The dressing is changed daily. Within a few days the definitive treatment is undertaken with further excision and repair of severed tendons and nerves. Skin closure is obtained by suture or graft.
      The results of this treatment in 881 cases is reported. Eight hundred and forty-one wounds healed without infection, 15 cases had small stitch abscesses or slight transitory erythema, and definite infection of the wound occurred in 25 cases. This amounts to a total of 2·8 per cent compared with 4·9 per cent of infections occurring in a series of 283 cases treated by primary suture.
      This method is considered satisfactory because there are relatively few cases of infection and as it allows early repair of divided tendons and nerves at a time when the patient is well prepared and operating conditions are at their best.
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