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my husband had a boating accident he was thrown into a lake
Sent to Health Experts January 02 02:15 PM

My husband had a boating accident he was thrown into a lake and had two bad cuts one on his knee (22 cm-avulsion-the paper from the E.R. said) and a smaller one on his shin. They cleaned it with a pressure wash, gavehim anibiotics IV and stitched it up. He had stitches under the skin and skin stitches 26 on his knee and some on his shin. The doctor in the ER said he did a "primary wound closing".They gave him a prescription for two antibiotics and pain medicine. Someone told me that he should have a "delayed wound closing". What kind of wound closing do you think is best? It is a really big cut on his knee. What should we look for? They told us to see an orthopedist and have stitches out in 10 days.

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Male , Age: 46

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He was seen in the emergency room. Got wounds cleaned and stitches and antibiotics and pain medicine.

Customer (name blocked for privacy)
Answer
January 2 2:56 PM (41 minutes and 26 seconds later)
         
REPLIEDCheck Mark

After an accident, the physical integrity and function of the injured tissue must be restored.

Primary wound closure is the closing of the wound nearer to the time of injury. Primary closure without tissue loss is almost always possible with clean wounds seen within 4 hr after injury. Primary closure of wounds in areas with poor blood supply (e.g., distal extremities) and contamination can generally be attempted if they are seen within 4 to 8 h and should be avoided if they present after 12 h from the time of the injury. Hence in your husbands' case I would feel comfortable about doing a priamry wound repair if he reached the ER within a maximum time of 12 hours after the accident.

Delayed primary closure is the approach of cleaning the wound, leaving the wound open under a moist dressing for approximately 4 to 5 days, and then suturing the wound if there is no evidence of infection. Heavily contaminated wounds, wounds resulting from high-energy missile injuries, or large wounds due to animal bites are ideal for delayed primary closure. Wounds contaminated by pus, vaginal discharge, feces, or saliva as well as those where treatment is delayed longer than 12 h should also be considered for open wound management.

So I think that primary closure was probably the right thing done in your husbands case given the location and the extent of his wound, of course you need to look for signs of infection (like increasing pain, discharge or fever) and report back if this happens, if everything stays well then you need to follow up as suggested,

Please remember to accept the reply if you find it useful. A BONUS and a positive rating would be duly appreciated,
regards
Dr. Gupta

Reply
January 2 3:05 PM (9 minutes and 9 seconds later)
         
Reply to Gaurav Gupta's Post: Thank you but now 4 days later his leg is swollen and reddened. What do you suggest?
Reply
January 2 3:06 PM (41 seconds later)
         
Is this a situation where the delayed closure would be better?
Answer
January 3 2:18 AM (11 hours and 11 minutes and 43 seconds later)
         
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January 3 8:29 AM (6 hours and 11 minutes and 31 seconds later)
         
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