Gunshot and blast injuries to the extremities. Management of soft tissue wounds by a modified technique of delayed wound closure.

Thirty-three soft tissue wounds to the extremities from high-energy missiles were treated in 26 patients by using a modified technique of delayed wound closure. The modifications included planned re-examination and, if indicated, re-debridement of the wound every 48 hours after the initial treatment, and temporary wound coverage with synthetic skin substitutes. With this approach we observed only one wound infection postoperatively. This finding demonstrates that these modifications may be helpful in the management of this type of injury, that is otherwise associated with a high complication rate, including wound infection.