SAQ 288 – Wound Care – elderly pretibial wound healing and closure timing

Wound Care – elderly pretibial wound healing and closure timing.

a. Patient factors

• Malnutrition.
• Peripheral vascular disease or chronic venous insufficiency.
• Diabetes.
• Corticosteroids, immunosuppression, or significant organ dysfunction.
• Smoking, obesity, peripheral oedema, immobility, anticoagulation, or fragile skin.

b. Wound factors

• Skin movement, dependent location, or poor regional vascularity.
• Infection or contamination.
• Excessive suture tension or poor skin-edge apposition.
• Crush injury, large size, problematic location, or significant depth.
• Missed foreign body, tendon injury, deeper injury, fracture, or open injury.

c. Delayed primary closure

• Late presentation, especially 24-48 hours after injury, or delayed facial wounds beyond 24 hours.
• Contaminated or infected wounds.
• Human or animal bite injuries where early closure is relatively contraindicated.
• Inability to oppose edges without excessive tension.
• Need for washout, further treatment, or subspecialty review before closure.
• High-risk patient factors such as advanced age, diabetes, renal impairment, steroid use, obesity, malnutrition, or smoking.