Transcript Wounds. Classification. Description of wound process. Running sore. Modern principles of

Wounds. Classification.
Description of wound
process. Running sore.
Modern principles of
treatment.
WOUND – be what mechanical damage of organism,
which is accompanied violation of integumentary
cilouse tissues (skin, mucus shells).
BASIC SIGNS OF WOUND
PAIN – depends on wound localization, damage of
nervous structures, character of injuring agent,
nervous - psychological state of organism.
BLEEDING – depends on the type of vessels and
character of their injuring, localization of wound, state
of local and general hemodynamics, state of the
convolutional system of blood.
GAPING – it is determined direction of wound in
relation to the lines of Langera.
Factors which must be taken into
account during classification of
wounds
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Genesis ( reasons of origin).
Degree of infecting.
Character of wound.
Attitude toward the cavities of
body.
Motion of wound channel.
Classification of wounds by the
character of wound
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Cut - vulnus incisum
Shaking - vulnus punctum
Chopped - vulnus caesum
Chopped - vulnus contusum
Squashed - vulnus conguassatum
Poisonous - vulnus venenatum
Gun shout- vulnus sclopetarium
Mixed- vulnus mixtum
Bitten - vulnus morsum
Lacerated - vulnus lacerum
By degree of infecting :
- aseptic, infected, purulent.
For the running of wound channel :
- blind, through, tangents.
In relation to body cavities:
- penetrable, nonpenetraiting.
On complication :
- simple, difficult.
On the area of damage– anatomic area
of body.
Combined wounds.
Features of gunshot wounds
1.
Area of primary wound channel, which is
diagnosed clinically at once after a wound;
2.
Area of primary traumatic necrosis, where a
parabiosis and grow stiff penetrate as separate
hearths, that clinically in the first clock after a
wound, establishing hardness;
3.
Area of molecular concussion, wherever
parabiotic changes in general clinically are not
established, but demonstrate, as a rule in future
at the inadequate debriding of wound and,
especially, at imposition of primary guy-sutures,
without the clear, adjusted testimonies on this
operation
Principle chart of
wound
cicatrization
І PHASE OF INFLAMMATION
period of vascular changes
Neurohumors of
inflammatory
reaction
System of
complement
Factor ХІІ
Proteolitichni and
hydrolysis
enzymes:
bacterial, cellular
Migration of
leucocytes is a
chemotaxis
increase of vessels
permeability
F
A
G
O
CI
T
O
Z
Haemostatic reaction
synthesis of collogen
Wound contration
Collagenaze
of granulation tissue
system of
complement
ІІ PHASE OF REGENERATION
Prolipheration of the cells
III PHASE OF REORGANIZATION
OF SCAR
Prostaglandines
Factors of
hemostasis
system I – XIII
a period of wound cleaning from
tissues which perished
Development of granulation
tissue
Bacterial
collagenaze
Neurohumors of
inflammatory
reaction: amines,
proteases,
polipeptides
Е
П
І
Т
Е
Л
І
З
А
Ц
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Я
Proteolitic
enzymes:
cellular,
bacterial
Factor XIII
Collagenesis of
granulation tissue
and epidermis
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It should be noted that mentioned
physiopathology processes take
place in any wound, regardless of
type of its cicatrization. A difference
consists only in quantitative
descriptions of the mentioned
phases, but not in high-quality.
Depending on it select cicatrization
primary healing, second healing,
through infiltrat and under a scab.
Differentially diagnostic signs of wound primary healing at
uncomplicated motion of wound process and at suppuration of
wound.
Criteria
of Uncomplicated motion
estimation
Motion, complicated
suppuration
by
GENERAL
1. General
condition
2. Pain
3.Temperatur
e of body
4.General
blood
analysis
Insignificantly worsened
after a wound, normalized
on 2-3 days. Sleep is not
broken.
Moderate, on 2-3 days
disappears
Rises after an operation
to 37,5-38 0 C, normalized
on 2-3 days
The acceleration of BSR
to
15-20
mm/h,
insignificant change, at
complete
normalization
An improvement does
not take place, pains
proceed, that violates
sleep.
Intensive, often
pulsating
Increase to 38-390S, or
proof subfibrilitet (37,237,6 0C)
All changes grow, or
absence of positive
dynamics.
ІІ. LOCAL
1. A
lymphangitis
limfadenit
2. Hyperemia
3. Edema
4. Infiltration
of tissues
5. Selection.
It is not observed
Insignificant, disappears
quickly
Insignificant, disappears
quickly
Insignificant, disappears
quickly
It is not practically
It is observed more frequent at
the defeat of extremities
Moderate, or expressed,
without a positive dynamics
Moderate, often making
progress
Moderate, grows often,
festering infiltrat is
determined
Serosal exsudate, quickly
passes to festering
ІІІ. KLINIKOLABORATORY
1. Bacteriological
control
2. Рh of wound
content
3. An amount of
albumen is in an
exsudate from a
wound
4. Cytology
5. Thermography
Growth is
sometimes
number < 105
not, or
microbal
Growth is marked.
Microbal number> 105
Proof acidosis(Ph< 7,0)
Early acidosis of wound
environment (Ph from 5,0
till 8,0)
Quickly diminishes from
15-25 till 2-6 g/l
The cellular elements of
blood, neytrophiles, are
kept.
Appearance
of
poliblasts,
fibrocytes,
fibroblasts.
Most intensity is on 2-5
days. A decline of t0 is
from 6-8 days.
Grows or stably at level
10-20 g/l
Mainly neytrofiles in
destruction of different
degree.
Acute increase t0 > 1,520С.
Surgical treatment
The radical debriding of wound
foresees the absolutely complete
carving of all changed or staggered
festering-inflammatory by the
process of tissues– „races” and
„pockets”, with careful hemostasis,
treatment, guy-sutures, antiseptics
and closing of wound defect, or one
of methods of plastic surgery.
The partial debriding is executed in the
cases when anatomic terms (location
vitally of important vascular and nervous
barrels, localization of wound) or general
state of patient (shock, endotoxicosis,
decompensation of diabetes) does not
allow to conduct radical operative
interference. The last must be executed
the experimental brigade of surgeons,
under the general anaesthetizing in the
conditions of operating-room, nowise not
in chambers or bandage room.
PRINCIPLES OF IMPLEMENTATION OF
DEBRIDING OF WOUND
- Dissecting of wound is on all draught;
- Revision of wound channel;
- Carving of edges of wound, its walls, bottom,
necretomy;
- Gemostaz;
- Proceeding in integrity of the damaged
organs and structures (by indications);
- Imposition of guy-sutures is on a wound with
the possible draining: passive, active, running
washed (by indications).
Methods of the improved debriding
of wounds
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Treatment of wound by the pulsating
stream of antiseptics.
Vacuum treatment of running sore.
Treatment of running sore by the ray
of laser.
Treatment of running sore by an
ultrasound.
Criosurgery of running sore.
The basic requirements for local
treatment in I phase of wound
process
Wide spectrum of antimicrobial action,
that conditioned :
- polymorphic of microorganisms in the
hearths of defeat;
- it is a presence of hospital cultures of
bacteria;
- polyrhesistensy to many antibiotics;
- relatively by the protracted terms of
authentication of exciters festeringinflammatory processes and
- establishment of their sensitiveness to
chemical drugs;
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Local anaesthesing and antyinflammatory
action.
Hydrophilic hyperosmolar basis which is able to
take in a ranoviy exsudate to 350 – 600 %
during 20 - 24 hours
Preparations must not cause osmotic shock at
healthy cages
Absence of local and alergic actions.
Proceeding in mycromicrocircullation in a
wound, stabilizing of cellular membranes
Good spreading for wound surfaces, moistening
of it and penetrations, in the wound cavities of
Ingibition of protheolitic enzymes and warning
of the second necrosises
To that end in the period of vascular
changes appoint aquasolubable antiseptics
(1% solution of dioxidin, 1% solution of
yodoliron, 0,02% solution of chlorhexidine,
and anthers). At the increase of exudation
preparations of choice are multicomponent
ointments on aquasolubable basis (Levosin,
Levomekol', Dioksizol', Oflokain, Nitacid and
anthers.). In the second period of phase of
inflammation (cleaning of wound) an
important value acquires the use of sorbents
(Aerovillages, Televin, Debrizan, Regenkur)
and proteolitichnikh enzymes (Trypsinum,
khimopsin, terrilitin).
The basic requirements are for
local treatment in the II phase of
wuond process
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The reliable protecting of granulation
tissues from a mechanical damage and
action of other negative factors.
Prophylaxis of the second infecting of
wound. Moderate drying action.
Normalization of exchange processes is
due to proceeding in
mycromicrocirculation.
The directed circulation of reparative
processes is in a wound
These requirements are answered by
liniments and emulsions (sintomicine,
Tetracyclinum, hentamicine
ointments) and preparations which
stimulate regeneration (5%-10%
metiluracile ointment, Solkoseril,
Aktovegin and athers.). Aerosols are
widely used with a anti-inflammatory
and stimulant action – Oxiciklozol',
Laevovinisolum, Olasolum, Panthenol.
The basic requirements are for
local treatment in the III phase of
wound process
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The reliable protecting of granulation tissue is
from a mechanical damage and action of other
negative factors.
Prophylaxis of the second infecting of wound.
A prophylaxis of anomalous proliferation and
differentiation of fibroblasts is with forming of
hypertrophic and celoid scars.
Acceleration of speed of epitelisation and decline
of intensity of contraktion of wound.
Directed stimulation and adjusting of reparative
processes in a wound with providing of optimum
terms for reorganization of scar
General treatment of running sore
Antibacterial therapy
 Imunocorrective therapy (specific,
heterospecific).
 Detoxicative therapy
- Infusion of crystalloids
- Method of the forced diurhesis.
- Application of detoxicative preparations.
- Extracorporal facilities of detoxication.
 Symptomatic therapy
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