Delayed primary closure of wounds over compound fractures can be accomplished by surgical means in a very high percentage of battle casualties. In a series of 2,393 closures of wounds over compound fractures, 93 per cent. had healed when the patients left the hospital.
The factors which seem to influence the success of this treatment are:
(1) Early and adequate surgical débridement of the wound.
(2) Rapid evacuation of the wounded to the rear medical installations, where this definitive treatment may be carried out.
(3) A low incidence of serious infection, which is due to the early surgical treatment mentioned above, and to the age and generally excellent physical condition of the patients involved. The use of sulfonamides and penicillin probably exerts a beneficial influence on this low incidence of infection. Controlled experimental proof of this is not available.
(4) Whole-blood transfusions to combat the anaemia, which is present in many of these wounded, ensure a higher percentage of successful surgical closures of wounds.