Clinical reference for closure decisions, time limits, and healing stages by wound type and location.
Maximum time from injury to primary closure (sutures, staples, or tissue adhesive). Clean wounds, no significant contamination.
| Location | Clean wound | Contaminated | Notes |
|---|---|---|---|
| Face / scalp | Up to 24 hours | Up to 12 hours | Excellent blood supply allows extended closure window. Cosmetic outcome priority. |
| Upper limbs | Up to 12 hours | Up to 6 hours | Standard time limits apply. Check tendon/nerve function before closure. |
| Trunk | Up to 12 hours | Up to 6 hours | Standard time limits. Consider deep layer closure for tension. |
| Lower limbs | Up to 8 hours | Up to 6 hours | Poorer blood supply, higher infection risk. Elderly and diabetic patients — be cautious. |
| Feet | Up to 6 hours | Avoid primary closure | High contamination risk. Consider delayed primary closure or secondary intention. |
| Hands / fingers | Up to 12 hours | Up to 8 hours | Good blood supply. Avoid tight closure — risk of compartment pressure in digits. |
| Bite wounds (human/animal) | Generally avoid primary closure | Exception: face bites — copious irrigation then primary closure. Augmentin cover. | |
| Puncture wounds | Do not close | High infection risk. Clean, dress, antibiotics if contaminated. Tetanus status. | |
Platelet plug and clot formation. Vasoconstriction then vasodilation. Inflammatory mediators released.
Neutrophils then macrophages clear debris and bacteria. Signs: redness, warmth, swelling, pain. This is normal and expected. Abnormal: spreading erythema, purulent discharge, fever.
Fibroblasts lay down collagen. Granulation tissue fills the wound (moist, pink/red, granular). Epithelial cells migrate across the surface. Wound contraction occurs in open wounds. Peak tensile strength gain during this phase.
Collagen reorganises and cross-links. Scar matures: red → pink → white/pale. Maximum tensile strength reached ~80% of normal skin at 3 months. Full remodelling can take 1–2 years.
Diabetes, peripheral vascular disease, immunosuppression, malnutrition, smoking, obesity, age >65, chronic kidney disease
Corticosteroids, immunosuppressants, anticoagulants (haematoma risk), NSAIDs (may impair early healing), chemotherapy
Infection, foreign body, excessive tension, poor blood supply, haematoma/seroma, repeated trauma, radiation
| Method | Best for | Avoid when |
|---|---|---|
| Tissue adhesive (glue) | Clean, low-tension, superficial lacerations. Face, scalp (through hair). Children. | Over joints, hands/feet, high tension, wet/mucous membranes, hair-bearing areas (use staples). |
| Steri-strips | Superficial, low-tension wounds. Skin tears in elderly. Adjunct after suture removal. | High tension, wet areas, hairy areas, deep wounds. |
| Sutures | Deep wounds, high-tension areas, cosmetically important areas (face). Best for precise edge approximation. | Contaminated wounds >time limit, crush injuries, puncture wounds. |
| Staples | Scalp, trunk, extremities where speed matters. Linear lacerations. | Face, hands, feet, over joints (less precise cosmesis). |
| Secondary intention | Contaminated/bite wounds, chronic ulcers, areas with good blood supply, small wounds in concavities. | Large defects on face (poor cosmesis), areas over tendons/bone. |
| Delayed primary closure | Contaminated wounds that would benefit from closure. Pack open 3–5 days, if clean then close. | If infection develops during observation period. |
Clean minor wound: Booster if last dose >10 years ago.
Tetanus-prone wound (contaminated, puncture, crush, devitalised tissue, >6 hours old): Booster if last dose >5 years ago. If incomplete primary course or unknown status: give tetanus immunoglobulin (TIG) and vaccine.
Tetanus-prone wounds also include burns, animal/human bites, wounds with foreign bodies, and compound fractures. Check the Australian Immunisation Handbook for full guidance.
Consider referral for: suspected tendon, nerve, or vessel injury; wounds involving joints or joint capsule; complex facial lacerations (especially eyelid, lip margin, ear cartilage, nasal cartilage); hand injuries with functional deficit; wounds requiring flap or graft; open fractures; wounds with significant tissue loss; heavily contaminated wounds requiring debridement under anaesthesia.