title: Is time to closure a factor in the occurrence of infection in traumatic wounds? A prospective cohort study in a Dutch level 1 trauma centre.
abstract: BACKGROUND
  The dogma that traumatic wounds should not be sutured after 6 h is based on an animal experiment by P L Friedrich in 1898. There is no adequately powered prospective study on this cut-off of 6 h to confirm or disprove the dogma. The aim of this study was to provide evidence against the dogma that wounds should be sutured within 6 h after trauma.
  
  
  METHODS
  425 patients were included in a prospective cohort study. Patients' wounds were closed, independent of time after trauma. All patients were seen after 7-10 days for removal of stitches and wound control on infection.
  
  
  RESULTS
  Of the 425 patients, 17 were lost to follow-up. Of the remaining 408 patients, 45 had wounds older than 6 h after trauma. At follow-up 372 patients (91%) had no infection and 36 patients had redness of the suture sites or worse. 11 patients (2.7%) had general redness or pus. Of those with a wound older than 6 h, three of 45 (6.7%) wounds were infected, versus 30 of 363 (9.1%) in wounds younger than 6 h (p=0.59).
  
  
  CONCLUSIONS
  In everyday practice wounds are sutured regardless of elapsed time. Here an attempt was made to present the evidence for this daily routine, contrary to Friedrich's Dogma.
authors.affiliation: Department of Surgery and Microbiology, Medisch Spectrum Twente, Enschede, The Netherlands. vandenbaar@hotmail.com
authors.forename: Mark T M
authors.initials: MT
authors.lastname: van den Baar
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
authors.forename: Marianne I
authors.initials: MI
authors.lastname: Vroon
authors.forename: Paul
authors.initials: P
authors.lastname: Bertelink
authors.forename: Ron
authors.initials: R
authors.lastname: Hendrix
mesh_terms: D000328:Adult; D015331:Cohort Studies; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D013536:Suture Techniques / Q000706:statistics & numerical data*; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014946:Wound Infection / Q000517:prevention & control* / Q000628:therapy; D014947:Wounds and Injuries / Q000628:therapy*