54.4 Delayed primary suture (dps)

This is the most widely useful way of closing a wound. It means closing a wound between the 3rd and the 7th day, usually on the 3rd day. It does not mean waiting for about 10 days until granulations have formed. That is secondary suture.

In nature all wounds heal by granulation, so that immediate primary suture is a recent human invention. Delayed primary suture is thus closer to the conditions under which human tissue evolved. Also, it makes good use of a universally available chemical which is lethal to the anaerobes causing gas gangrene—the oxygen of the air. The main way in which wound care in most hospitals needs changing is: (1) more emphasis on a really adequate wound toilet, and (2) much less on immediate primary closure. Many tragedies, including osteomyelitis and death, result from treatment which is perfect in every way, except that the wound was sutured immediately, when delayed closure would have been wiser. The temptation is great because a wound looks so much tidier when it is neatly sewn up! Unfortunately, dirt, dead tissue and bacteria may all be hidden under a beautifully sutured wound. If a patient arrives in your ward with his wound sutured, and you are not sure about the adequacy of the toilet, or the correctness of immediate primary suture, reopen his wound and look at it. If necessary, leave it open and suture it later.