The impact of wound age on the infection rate of simple lacerations repaired in the emergency department.
Level 3 - non-randomized controlled study
Systematic review of predominantly non-randomized observational studies
PubMed 22424703 · doi:10.1016/j.injury.2012.02.018
What was done
Authors conducted a systematic review searching MEDLINE, EMBASE, and other databases to evaluate whether primary closure of simple lacerations after a proposed "golden period" increases wound infection risk in emergency department patients. Studies were included if they compared infection rates between early and delayed presentations for primarily closed simple lacerations. Studies involving gross contamination, secondary closure, or extensive surgical debridement were excluded. Study quality was evaluated using GRADE criteria.
What was found
Four studies enrolling 3,724 total patients were identified. Infection rates in delayed presentation groups ranged from 1.4% to 32%. Only one small trial focusing strictly on hand and forearm lacerations (19 delayed wounds) found an increased infection rate beyond 12 hours (relative risk 4.8, 95% CI 1.9–12.0). The other three included studies found no statistically significant difference in infection rates between early and delayed presentation groups.
Why it matters
This review challenges the traditional textbook dogma of a strict 3- to 24-hour "golden period" cutoff, suggesting that simple, uncomplicated lacerations may not necessarily face higher infection rates when closed primarily after a delay.
Limits
Only four studies met the inclusion criteria, and aggregate evidence quality was rated as low by GRADE criteria. Definitions and time cutoffs for delayed closure varied across the included trials, and specific high-risk anatomical sites (such as the hands) were poorly represented across the larger studies.
Cited by
- contradicts Lacerations must be sutured within 6 hours of injury to avoid wound infection.