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June 1976

Primary Repair of Colonic Injuries

Arch Surg. 1976;111(6):724. doi:10.1001/archsurg.1976.01360240104023

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To the Editor.—I am writing concerning the article by Matolo et al, "Experimental Evaluation of Primary Repair of Colonic Injuries" (Arch Surg 111:78-80, 1976). I think the authors offer an important contribution in showing that clean, incised wounds of the colon will heal in the presence of infection. However, in a clinical setting, this finding applies only to low-velocity penetrating injuries, such as stab wounds. It does not apply to the high-energy penetrating wounds produced by high-velocity gunshot or a close-range shotgun wound, nor does it apply to perforations induced by blunt trauma. Both blunt injuries and high-velocity penetrating injuries are surrounded by a margin of contusion injury that extends beyond the obvious open edges. Since this area develops subsequent to the "blast" effect of these injuries, it needs time to appear. It does become manifest at the time of an early laparotomy. Therefore, due to the inability to

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