Intended for healthcare professionals

Clinical Review

Lesson of the week: Delayed closure of injuries to the hand caused by blasts helps to preserve function

BMJ 1997; 315 doi: (Published 01 November 1997) Cite this as: BMJ 1997;315:1146
  1. I Grant, surgical research fellow (
  1. a Blond McIndoe Centre, Queen Victoria Hospital, East Grinstead, Sussex, RH19 3 DZ,
  • Accepted 19 May 1997


Proper treatment of hand injuries can greatly reduce the chance of disability in people who are otherwise healthy. The importance of the initial management of such injuries has been recognised by those caring for people who have been wounded in wars over the past 60 years.1 The hand surgeon Alfred Swanson drew on his experience in the Vietnam war to formulate fundamental rules for managing hand wounds.2 He concluded that injuries to the hand caused by a blast are best left open, with primary closure being performed after three to seven days.

An injury caused by a blast introduces a large amount of contaminating material into the tissues. Some material will remain no matter how scrupulously a debridement is performed. The primary closure of blast wounds invites infection.3 During the healing process wounds become …

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