title: Below-knee amputations as a result of land-mine injuries: comparison of primary closure versus delayed primary closure.
abstract: BACKGROUND
  Antipersonnel land mines are designed to maim by mutilating the lower extremities, and these injuries are at higher risk for infection than injuries from other weapon systems.
  
  
  METHODS
  The results of 474 unilateral traumatic below-knee amputations as a result of land-mine injuries were reviewed. If the delay in evacuation between the injury and arrival to the battle field hospital was less than 6 hours, 392 amputation stumps (group I) were closed primarily after meticulous debridement. Open amputation was performed after debridement in the remaining 82 amputation stumps (group II), because there was a suspicion of ineffective debridement, although they were evacuated in less than 6 hours or delay was more than 6 hours.
  
  
  RESULTS
  Eleven patients in group I (2.8%) were reoperated because of wound sepsis of the stump. Wound sepsis was not encountered in group II. A total of 87.4% of stumps in group I and 81.2% of stumps in group II had healed without a problem. No gas gangrene or tetanus was encountered in any cases.
  
  
  CONCLUSIONS
  Our results reveal that primary closure may be done in traumatic below-knee amputations caused by land-mine injuries with an acceptable infection rate, if the evacuation time is less than 6 hours, and if there is meticulous debridement.
authors.affiliation: Gülhane Military Medical Academy, Department of Orthopaedics, Etlik, Ankara, Turkey.
authors.forename: A S
authors.initials: AS
authors.lastname: Ateşalp
authors.forename: K
authors.initials: K
authors.lastname: Erler
authors.forename: E
authors.initials: E
authors.lastname: Gür
authors.forename: C
authors.initials: C
authors.lastname: Solakoglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D001753:Blast Injuries / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003646:Debridement / Q000379:methods; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D013536:Suture Techniques; D013997:Time Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data; D014421:Turkey; D014754:Violence; D014945:Wound Healing