Complications:
(1) dehiscence
(2) surgical site infection
(3) osteomyelitis
Risk factors:
(1) single layered closure
(2) high body mass index (BMI)
(3) delay between injury and surgery (mean 10 days), typically treated as an outpatient
(4) smoking cigarettes
Lower risk:
(1) double-layered closure
(2) normal body mass index
(3) admitted shortly after injury with relatively prompt surgery (mean 4.8 days)
(4) nonsmoking
where:
• Possible explanations for lower risk with double-layered closure include: (1) greater number of fascial sutures, (2) less tension on skin edges, (3) less ischemia at the skin edges.
• The mean BMI for patients was 25.7. A normal BMI is < 25 kg per meter square. Most of the patients in the study appear to have had normal weight or Grade I (BMI 25 - 29.9 kg per meter square) obesity (see discussion on BMI in Chapter 2).
• I would imagine a malnourished person with low BMI might be expected to have defects in wound healing and a greater risk of complications.
• Patients with higher BMI tended to have more comminuted fractures. Because of slow wound healing in patients with high BMI and comminuted fractures, sutures were left in for a longer period of time (at least 4 weeks after surgery).
• I was unable to find a cutoff for the BMI to identify higher risk patients. For the implementation I will use BMI >= 27 and comminuted fracture as the risk factor.
• An interval > 5 days between injury and surgery is given in the abstract as the time associated with higher risk.
• Smokers who quit smoking perioperatively did better than those who did not.
Limitations:
• The study was retrospective.
