Below-knee amputations as a result of land-mine injuries: Comparison of primary closure versus delayed primary closure

Background: Antipersonnel land mines are designed to maim by mutilating the lower extremities, and these injuries are at higher risk for infection tha n injuries from other weapon systems, Methods: The results of 474 unilateral traumatic below-knee amputations as a result of land-mine injuries were reviewed, If the delay in evacuation be tween the injury and arrival to the battle field hospital was less than 6 h ours, 392 amputation stumps (group I) were closed primarily after meticulou s debridement, Open amputation was performed after debridement in the remai ning 82 amputation stumps (group II), because there was a suspicion of inef fective debridement, although they were evacuated in less than 6 hours or d elay was more than 6 hours, Results: Eleven patients in group I (2.8%) were reoperated because of wound sepsis of the stump. Wound sepsis was not encountered in group II. A total of 87.4% of stumps in group I and 81.2% of stumps in group II had healed w ithout a problem, No gas gangrene or tetanus was encountered in any cases. Conclusion: Our results reveal that primary closure may be done in traumati c below-knee amputations caused by land-mine injuries with an acceptable in fection rate, if the evacuation time is less than 6 hours, and if there is meticulous debridement.