What action is necessary if primary closure is not obtained with a 3-4mm opening?

When a primary closure is not achievable with a 3-4mm opening, scoring the periosteum can be an important step. This technique involves incising the periosteum to help release tension in the surrounding tissues, which can allow for better approximation of the wound edges. By scoring the periosteum, you promote more flexibility and mobility in the tissue which can enhance the capability for achieving primary closure.

In this context, primary closure is often the preferred method for wound healing, as it typically results in minimal scarring and a more efficient healing process. If primary closure is not initially achievable, using a technique such as periosteal scoring can make it possible to close the wound effectively.

The other options present alternative approaches. Leaving the wound to heal secondarily may lead to prolonged healing times and potentially greater scarring. Applying a graft over the area would generally be considered if primary closure is not feasible, but it is usually not the first line of action if there is a possibility of achieving closure. Lastly, while using a tension-free closure technique is important in some situations, scoring the periosteum directly addresses the underlying issue of tension that is preventing primary closure.