The primary phase of wound healing begins at the time of
wounding and is, therefore, well established by the time of presentation if the
wound is several days old. With the addition of surgical excision, many wounds
cannot be closed within seven days, in total, from the time of injury. If direct
suture is attempted the wound edges can only be approximated under considerable
tension, and extensive undermining of the skin edges to allow closure will often
be associated with a large subcutaneous dead space and haematoma. Wounds treated
in this fashion have a high incidence of infection and breakdown.
This is not delayed primary closure and should not be
regarded as such. The majority of these wounds are unsuitable for DPC and
require skin grafting, or specifically designed skin flaps, for closure.
Most delayed or neglected wounds will be unsuitable for delayed