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Invited Commentary
August 2013

Please Pack Open Your Dirty Wounds!

Author Affiliations
  • 1Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio
JAMA Surg. 2013;148(8):786-787. doi:10.1001/jamasurg.2013.2343

Suppuration may be considered a resolution but it is a mode of resolution which we mainly wish to avoid.

John Hunter,1 (1728-1793)

Bhangu and colleagues1 recently performed a review of the literature comparing the impact of wound management with delayed primary closure (DPC) vs primary closure (PC) on subsequent wound infection. They analyzed 8 randomized trials that they found to be highly heterogeneous and some quite flawed. Most studies did not establish uniform techniques for wound care and some failed to strictly define wound infection or how the presence of this complication was adjudicated. Not surprisingly, the outcomes were inconsistent, their meta-analysis showed a large amount of variability and bias, and the final results were inconclusive. It appears that sloppy methods eliminated the potential to identify consistent benefit to a particular technique in the majority of prior investigations.

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