Brian Lin is back for the second part of our conversation with him from the 2017 SEMPA 360 conference, but this time we are talking about two subjects with a lot of dogma: the Golden Period for wound closure and dog bite closure. This brief review is designed to remind you of some of the key components in order to better care for your patients.
In a well-cited post by Brian, he covers the Golden Period in detail (the same post we got the above picture from). No, this is not the Golden Hour for trauma. Instead, it refers to the length of time a wound can remain open before it is too risky to close primarily. The evidence (or lack thereof) may surprise you. Like most dogma, its roots take place in some poor data that today would not hold up to the skeptical eye. Yes, it may have been good at the time, but when Professor Paul Leopold Friedrich in 1898 lacerated the skin of guinea pigs and inoculated the wounds with feces to see how excise of the surrounding could be delayed before animals would die, I do not believe his timeline of six hours necessarily translates to humans. On the podcast, we talk about some of the better data and the more accurate timeline.
Primary closure of dog bites is another type of wound fraught with dogma. In Part One of a two part post, Brian tackles some of the key concerns with the initial treatment and approach prior to closure of such wounds with a real case as part of the story on how to take care of these situations. Part Two covers more of the approach to closure itself and prophylactic antibiotics. It is well worth visiting Brian's site for the details, along with other great information on how to manage wounds at his lacerationrepair.com site.
SEMPA 360 was a lot of fun. If you could not make it or want to listen again, check out Virtual SEMPA for more information. Have you had similar cases you want to share? We would love to hear about it! Also, please let us know what you think by giving us feedback here in the comments section or contacting us on Twitter or Facebook. Remember to look us up on Libsyn and on iTunes. If you have any questions you can also comment below, email at firstname.lastname@example.org, or send a message from the page. We hope to talk to everyone again soon. Until then, continue to provide total care everywhere.
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