Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XXI: Amputations
United States Department of Defense
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The timing and the method of wound closure require as great a measure of surgical judgment as did the original decision to amputate. Delayed primary closure is not indicated in open circular amputations. Continued traction will often result in the skin eventually closing over the end of the stump. If it does not, small split-thickness skin grafts can be used. A definitive revision may be necessary later, but it can be performed at higher echelons which permit immediate fitting techniques, thereby allowing more rapid prosthetic application. Delayed primary closure too often results in a chronically inflamed, edematous, indurated, and sometimes draining stump that is unreceptive to prosthetic application.
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