Primary signs indicating the development of suppuration. How to identify pus. Pus on the leg

An accidental wound is contaminated with microflora introduced by a wounding weapon or falling from clothing, earth, skin ( primary infection). If microbial flora is introduced into the wound during dressings, this infection is called secondary... The types of microbial flora are extremely diverse, most often they are streptococci, staphylococci, Escherichia coli... In rare cases, infection occurs anaerobic:

During primary infected wounds are distinguished by a latent period, a period of spread and a period of localization of infection. In the first period, there are no clinical manifestations of infection. Depending on the type of microbial flora, it lasts from several hours to several days. In the second period, swelling, redness, swelling, pain appear around the wound, lymphangitis and lymphadenitis... In the third period, the process is limited, the further spread of infection and the absorption of toxic products into the blood cease, and a granulation shaft is formed.

Symptoms of Purulent Wounds

The general reaction of the body is expressed in an increase in body temperature, an increase in heart rate, an increase in the number of leukocytes in the blood. When examining the wound, pus is found. Pus is an inflammatory exudate with a significant content of protein, cellular elements, microbial flora, wound enzymes. At the beginning of the inflammatory process, pus is liquid, later thick. The type of pus, smell, color depends on the microbial flora that caused the inflammatory process. Over time, in the old purulent cavities, the microbial flora in the pus disappears or loses its virulence.

Causes of Purulent Wounds

The factors contributing to the development of infection in the wound include the pathogenicity of the microbial flora, contamination of the wound, a long tortuous wound channel, the presence of a hematoma, numerous cavities, and poor drainage from the wound. Exhaustion, decreased immunoreactivity negatively affects the course of the inflammatory-purulent process. The infection remains confined to the wound during the first 6-8 hours. Microbes and their toxins spread through the lymphatic tract, causing inflammation of the lymphatic vessels and nodes. With developing suppuration, redness of the skin, swelling of the edges of the wound, sharp pain on palpation are noted.

Treatment of festering wounds

Treatment of purulent wounds consists of two directions - local and general treatment. In addition, the nature of the treatment is determined by the phase of the wound process.

Local treatment of purulent wounds... In the first phase of the wound process (inflammation phase), the surgeon has the following main tasks:

  • Fighting microorganisms in the wound.
  • Ensuring adequate drainage of exudate.
  • Promoting the early cleansing of the wound from necrotic tissue.
  • Reducing the manifestations of the inflammatory response.

For local treatment of purulent wounds, methods of mechanical, physical, chemical, biological and mixed antiseptics are used.

With suppuration of a postoperative wound, it is usually sufficient to remove the sutures and widen its edges. If these measures are not enough, then it is necessary to perform secondary surgical debridement (WMO) of the wound.

Secondary surgical debridement of the wound. Indications for VHO wounds are the presence of a purulent focus, lack of adequate drainage from the wound (pus retention), the formation of extensive zones of necrosis and purulent streaks. A contraindication is only an extremely serious condition of the patient, while they are limited to opening and draining the purulent focus.

Tasks for the surgeon performing VCO wounds:

  • Opening of a purulent focus and streaks.
  • Excision of non-viable tissue.
  • Implementation of adequate wound drainage.

Before starting VHO, it is necessary to determine the visible boundaries of inflammation, the localization of the area of ​​purulent fusion, the shortest access to it, taking into account the location of the wound, as well as possible ways of spreading the infection (along the neurovascular bundles, muscle-fascial sheaths). In addition to pallator examination, in this case, various types of instrumental diagnostics are used: ultrasound, thermographic, X-ray (with osteomyelitis), computed tomography.

Like the primary surgical treatment, VHO is an independent surgical intervention. It is performed in the operating room by a team of surgeons using anesthesia. Only adequate anesthesia can solve all the tasks of VHO. After opening the purulent focus, a thorough instrumental and digital revision is carried out along the course of the wound itself and the possible finding of leaks, which are subsequently also opened through the main wound or counterperture and drained. After performing the revision and determining the volume of necrosis, evacuation of pus and excision of non-viable tissues (necrectomy) are performed. At the same time, one should not forget that large vessels and nerves may be located near or in the wound itself, which must be preserved. Before the end of the operation, the wound cavity is rinsed abundantly with antiseptic solutions (hydrogen peroxide, boric acid, etc.), loosely tamponed with gauze napkins with antiseptics and drained. The most beneficial method of treatment for extensive purulent wounds is flow-lavage drainage. In the case of localization of damage to the limb, immobilization is required.

Treatment of a purulent wound after surgery... After performing VHO or simple opening (opening) of the wound at each dressing, the doctor examines the wound and assesses its condition, noting the dynamics of the process. The edges are treated with alcohol and an iodine-containing solution. The wound cavity is cleaned with a gauze ball or napkin from pus and free-lying sequestered areas of necrosis, necrotic tissue is excised by an acute method. This is followed by rinsing with antiseptics, drainage (if indicated) and loose plugging.

Treatment of purulent wounds with pancreatitis affects one of the most important organs - the pancreas, which causes severe pain. The pancreas helps digest fats, proteins and carbohydrates in the intestines, and the hormone insulin regulates blood glucose levels. Pancreatitis occurs due to - a blockage of the gallbladder or the duct of the gland itself, infection, helminthiasis, trauma, allergies, poisoning, often drinking alcohol. The main component of treating the pancreas is a diet in which you have to fast for the first two to three days. And you will have to exclude after treatment fatty, fried and spicy foods, alcohol, sour juices, strong broths, spices, smoked products. The diet begins on day 4, while you can eat at least 5-6 times a day in small portions. During the diet, it is better to eat some types of fish, meat, mild cheese, fresh low-fat cottage cheese. Fats must be reduced to 60 g per day, excluding lamb and pork fat from the diet. Limit sweets and carbohydrate foods. Food should always be warm when consumed. Thanks to all this, the restoration of the pancreas occurs. And in order to prevent pancreatitis from reoccurring, follow all the tips written above.

In the first phase of healing, when there is abundant exudation, ointment preparations cannot be used, since they create an obstacle to the outflow of secretions, in which there are a large number of bacteria, proteolysis products, and necrotic tissues. During this period, the dressing should be as hygroscopic as possible and contain antiseptics. They can be: 3% boric acid solution, 10% sodium chloride solution, 1% dioxidine solution, 0.02% chlorhexidine solution, etc. Only for 2-3 days it is possible to use water-soluble ointments: "Levomekol", "Levosin", " Levonorsin "," Sulfamekol "and 5% dioxidine ointment.

Of particular importance in the treatment of purulent wounds is "chemical necrectomy" with the help of proteolytic enzymes that have necrolytic and anti-inflammatory effects. For this, trypsin, chymotrypsin, chymopsin are used. The drugs are poured into the wound dry or injected in a solution of antiseptics. For active removal of purulent exudate, sorbents are placed directly into the wound, the most common of which is polyphepan.

In order to increase the effectiveness of WMO and further treatment of purulent wounds in modern conditions, various physical methods of exposure are used. Ultrasonic cavitation of wounds, vacuum treatment of a purulent cavity, treatment with a pulsating jet, various methods of laser application are widely used. All these methods are aimed at accelerating the cleansing of necrotic tissues and destructive effects on microbial cells.

Treatment in the regeneration phase... In the regeneration phase, when the wound has cleared of non-viable tissues and the inflammation subsided, the next stage of treatment is started, the main tasks of which are suppression of infection and stimulation of reparative processes.

In the second phase of healing, the process of formation of granulation tissue plays a leading role. Despite the fact that it also carries a protective function, it is impossible to completely exclude the possibility of re-inflammation. In this period, in the absence of complications, exudation is sharply reduced and the need for a hygroscopic dressing, the use of hypertonic solutions and drainage disappears. Granulations are very delicate and vulnerable, therefore it becomes necessary to use drugs on an ointment basis, which prevents mechanical trauma. Antibiotics (synthomycin, tetracycline, gentamicin ointments, etc.), stimulating substances (5% and 10% methyluracil ointment, "Solcoseryl", "Actovegin") are also introduced into the composition of ointments, emulsions and lenients.

Multicomponent ointments are widely used. They contain anti-inflammatory substances that stimulate regeneration and improve regional blood circulation, antibiotics. These include "Levomethoxide", "Oksizon", "Oxycyclosol", balsamic liniment according to A. V. Vishnevsky.

To accelerate wound healing, the technique of applying secondary sutures (early and late) is used, as well as tightening the edges of the wound with an adhesive plaster.

Treatment of wounds in the phase of scar formation and reorganization... In the third phase of healing, the main task is to accelerate the epithelialization of the wound and protect it from unnecessary trauma. For this purpose, dressings with indifferent and stimulating ointments are used, as well as physiotherapy procedures.

Purulent inflammation is a fairly relevant topic for discussion, since recently more and more people have begun to go to doctors with similar problems. The reasons for such a sharp deterioration in the health status of the population can be various factors. We want to talk about them and many other things in our article. The information collected is aimed at helping those affected by this disease.

What is inflammation

Purulent inflammation is one of them, and before we begin to deal with its types, we need to understand what it is. Even ancient healers determined that this is a protective reaction of the human body to an irritant. Both a virus and a splinter can act as an irritant. There are many terms that characterize this process, but the most basic is phagocytosis, which the famous Mechnikov spoke about, that is, the process of destroying an irritating agent inside a cell.

Causes of purulent inflammation

In medicine, several possible reasons are known when rotting begins. Some of the most common options include:

  • the ingress of infections and their toxin into the human body;
  • the consequences of exposure to external factors, such as burns, radiation, frostbite;
  • the consequences of bruises or other types of injuries;
  • contact with chemical irritants;
  • internal processes in the body, such as or salt deposition.

What happens at the moment when purulent tissue inflammation begins? To understand the essence, let's take the simplest example: being hit by a splinter. When it just got into the skin, it is absolutely impossible to pull it out, but after a while we can easily remove it from the skin along with the pus, which has time to collect. What happened, and why did the pus collect, how did the purulent inflammation begin? A splinter that gets into the skin is perceived by the body as a foreign body and a threat. How does the body react? It increases blood flow to the affected area, blood brings with it many useful elements that work like a clock, and each of them performs its task:

  • the platelet sticks to its own kind and forms, thus, a protective layer on the wound;
  • the erythrocyte supplies the affected area of ​​the skin or organ with oxygen;
  • plasma brings nutrients for early wound healing;
  • white bodies (leukocytes) come into battle with a foreign body directly.

Where does pus come from? The fact is that in the process of the struggle, the white blood cells die, their role is to grab a foreign body, absorb it and destroy it. But, destroying the enemy, the leukocyte itself is destroyed, while acquiring a yellowish color, this is pus. If, in the process of fighting the irritant, some parts of the skin or organ die off, then the leukocyte also grasps the dead parts in order to prevent them from developing the process in the body. Thus, the leukocytes lay the pus upward. If you have pains when pressing on a purulent inflammation, it means that the nerve endings, which are huge in the body, were affected here. In this case, you need to carefully examine the affected area so as not to get a complication.

Forms of inflammation

Considering where the process began, and how strong or weak a person's immunity is, we can distinguish the following forms of purulent inflammation:

  • Abscess - this is the name of a purulent formation that forms in the tissue, while it is allocated in a separate capsule. The formation of an abscess indicates a good one. A protective crust immediately begins to form around it, preventing the spread of infection. Often this is characterized by purulent inflammation of the tooth.
  • Phlegmon - characterized by a looser consistency of formation, which most often occurs in the space between the muscles. It is an indicator that a person does not have very good immunity. Most often, the patient is admitted to the hospital to solve the problem.
  • Empyema is the collection of pus in organs with a hollow structure. In this case, the natural tissue of the organ is the boundaries of the abscess.

The course of purulent inflammation

This kind of inflammation is of two types: acute and chronic. Acute purulent inflammation spreads rather quickly, and soon we can observe a splash of exudate outward, either on the surface of the skin, or in the adjacent cavity of the organ. A large amount of pus can lead to intoxication of the body, and, as a result, to its depletion. Chronic purulent inflammation changes the composition of the cell, and lymphocytes and microphages begin to appear in its composition. Also, this form is characterized by the formation of scars and hardenings, but all this is possible only with the wrong decision.

Outcome of the disease

Of course, the outcome of the disease, like any other disease, depends on the correct treatment and the nature of the wound. What should be feared first of all?

  • Scarring. Scars are rarely adorned after an unsuccessful fight against inflammation.
  • Bleeding. If the disease has reached the lymph nodes, then there may be just such a variant of the outcome.
  • Gangrene. This is one of the most terrible options, tissue death begins, that is, necrosis.

Purulent inflammation of the skin

Most often, we all are faced with just this type of inflammation. In what options can we see it?

  • Pyoderma - appears due to improper handling of insect bites, small incisions in the skin, etc. On the skin it looks like small bubbles around the wound.
  • Follicle - in this case, the hair sac is at risk, it begins to fester.
  • A boil is the melting of a hair follicle. A dangerous factor is that it very easily develops into a disease of furunculosis, when many such formations are already observed.
  • Carbuncle - also but large in size, is usually treated using surgical methods, after which a large empty cavity remains in the skin, then scars appear at the site of the wound.
  • Hydradenitis is a purulent formation in the groin or armpit in the place where the sebaceous glands are located.

Complications

How the decay process ends depends on several important factors:

  • the degree of aggression of the annoying element;
  • penetration depth of infection;
  • the quality of the victim's immunity.

After the treatment has ended and the cavity with pus has emptied, soft tissue remains in its place, which is then replaced by fresh skin, but scars may appear. If the treatment was not carried out correctly, then a complication process may begin, which does not reflect well on the human condition:

  • pus can spread to other tissues and organs;
  • in the process of decay, the infection can enter the bloodstream, and, as a result, sepsis, bleeding and thrombosis can begin;
  • dying off of the skin and organ tissues;
  • weakening of immunity and the general condition of the human body, which can lead to underdevelopment of organs.

Treatment

Depending on the severity of the disease, treatment takes place. Both home treatment and surgery, as well as inpatient treatment are allowed.

Consider the options for possible treatment:

  • with an abscess, a person is made an incision and the cavity where there was pus is washed, the wound is closed from the effects of the environment;
  • with phlegmon, it is necessary to use drugs after opening the abscesses and deep cleaning;
  • with epyema, surgical intervention is necessary, when the organ tissue is opened, pus is removed, the cavity is cleaned, then intensified treatment is carried out aimed at raising the immune system and healing the wound.

It is important to know that when treating all sorts of abscesses, contact with water must be avoided, no compresses or massages should be done so as not to provoke the spread of infection. The skin must be treated with special products for the same purpose. Zelenka and iodine are the most common alcoholic solutions used for this purpose.

If you are faced with an elementary splinter, then, of course, you can deal with it at home, but you also need to be very careful. Before removing the splinter, you need to carefully treat both the affected area of ​​the skin and the instrument with which you will remove it. After removal, you must immediately treat the skin with alcohol and seal the wound with a plaster until healing or a protective crust forms.

Antibiotics

The use of antibiotics is allowed only under the strict supervision of the attending physician. Self-medication is not allowed, as this can significantly worsen the patient's condition. Before you start taking a medicine, you need to determine a person's sensitivity to its components. Of course, it is not recommended to use antibiotics unless they are urgently needed. It is important to remember that the use of antibiotics, especially uncontrolled use, can harm the normal functioning of the body. After you have a suspicion of the presence of purulent inflammation, urgently contact a specialist for help. If you have undergone surgery and scars remain, then modern plastic surgery can correct any deficiencies.

Various injuries to the skin are called wounds. Most often, they are harmless and are treated at home. But sometimes even minor damage to the skin leads to inflammation. Suppuration often occurs on the hands or feet, especially during the warmer months. Various skin lesions can become inflamed due to non-compliance with hygiene rules, reduced immunity, or the presence of chronic diseases. In some cases, self-treatment of purulent wounds on the legs does not help, and it is necessary to carry it out in a hospital. It is very important to notice the appearance of pus in time and use the drugs necessary to remove it. If this is not done, inflammation can lead to the development of various complications.

wound?

This is damage to the skin, accompanied by the development of pathogenic microorganisms in it. Pus begins to form in the wound, swelling and redness are observed around it. The tissues are painful and often hot to the touch. Dull throbbing pain is felt, often severe. In severe cases, local symptoms are joined by general ones: increased body temperature, intoxication of the body, headache.

Causes of the appearance of purulent wounds

The inflammatory process can develop due to infection of the resulting injury. This is due to getting into. Very often this happens in the summer, especially if the skin on the legs is damaged. The appearance of a purulent process can also occur after surgery. Therefore, it is recommended to perform operations in the cold season and to observe sterility in patient care. Such purulent wounds are called secondary. But there are also primary wounds. They are characterized by the breakthrough of an internal abscess without external damage to the skin. It can be either a regular boil.

Such wounds are treated mainly with surgical opening and antibiotics. The appearance of a purulent process is influenced by the age and state of the patient's immunity, the presence of chronic diseases, especially diabetes mellitus, in which suppuration develops very often. Most often, purulent wounds appear in the elderly, complete and weakened by diseases. Home treatment will be difficult in this case.

Phases of development of the wound process

Features of the treatment of a purulent wound depend on the stage of its healing. Most often, two phases of the wound process are distinguished:

At the first stage, it is necessary to eliminate edema, remove dead tissue, and also eliminate hemorrhage and an inflammation focus;

At the second stage, tissue regeneration and scar formation occurs. The healing of purulent wounds at this time can be accelerated by the use of special preparations. Modern medicines help to quickly regenerate tissue without the formation of a highly visible scar.

Purulent wound - treatment

Ointments for quick healing are now available to everyone. Therefore, the treatment can also take place at home. But if you do not cope with the inflammation in time, serious complications can appear. Correct treatment of purulent wounds on the legs includes several areas:

Wound treatment - removal of pus, dirt and dead skin.

Removal of inflammation, swelling and soreness of the skin.

Fight bacteria.

Acceleration of wound healing and stimulation of tissue scarring.

General treatment aimed at increasing immunity and combating intoxication. It consists in taking immunomodulatory and vitamin preparations.

In severe cases, treatment of purulent wounds on the legs may require surgical intervention: opening and cleansing the focus of inflammation, and sometimes amputation.

How to properly handle a wound?

Proper care of the affected skin area is very important for faster healing and prevention of complications. In mild cases, you can do this yourself. Treatment of purulent wounds is carried out 1-2 times a day and includes:

Thorough disinfection of the hands and tools used for this is most often done with alcohol.

Removing the old bandage. Moreover, this must be done very carefully, and when the bandage dries, it must be soaked with "Chlorhexidine" or hydrogen peroxide.

Careful removal of pus from the inside of the wound, treatment of its edges with an antiseptic in the direction from it to the edges and draining with a sterile swab. Sometimes it is recommended to lubricate the edges of the wound with brilliant green or iodine.

Application of the drug or a napkin moistened with it. If the wound is very deep, tampons or drainage are inserted into it to better drain the pus.

Closing the wound with sterile gauze in several layers and securing it with adhesive plaster or bandage. It is necessary to ensure that there is air access to the wound, otherwise an anaerobic infection may develop.

In a serious condition of the patient, open purulent wounds are treated 3-4 times a day, each time leaving them in the air for 20-30 minutes.

Physical treatments

Previously, an open method of healing purulent wounds was practiced. It was believed that under the influence of air and sunlight, microorganisms die faster. In recent years, this has been abandoned, and a bandage is imposed on the wound. Of the physical methods of treatment, quartzing, ultrasonic cavitation, UHF and laser irradiation are now used.

Antibiotics for purulent wounds

In severe cases, antibacterial drugs are used to prevent the development of general blood poisoning and more quickly release the wound from infection. If their use is required in the first stage, when the pathogen is still unknown, they are prescribed.They can be used in the form of tablets, injections and local solutions or ointments. Only a doctor should prescribe an antibacterial drug, after taking an analysis for the causative agent of the infection. After all, the inflammatory process can be caused not only by common staphylococci or streptococci, but also by Xibella, Proteus, Escherichia coli and even Shigella and Salmonella. Most often, sulfa antibiotics are used for purulent wounds, an emulsion of streptocide and sulfidine is applied externally. The best known antibacterial drug is penicillin.

External remedies to relieve inflammation

At the first stage of the development of a purulent process, it is recommended to use funds and ointments on a water-soluble basis, it is better if they contain antibiotics. The most commonly used are "Levomekol", "Levosin" and others.

Treatment of purulent wounds on the legs can be complicated by the fact that inflammation is caused by many microorganisms, often even a fungus joins. Therefore, it is advisable to use complex products, for example, "Iruksola". Antiseptic solutions are often used to treat wounds. The most famous of them - "Furacilin", hydrogen peroxide and sometimes turn out to be ineffective due to the appearance of microorganisms resistant to their action. New drugs are now being produced: "Dioxidin", "Yodopiron", "Sodium hydrochloride" and others.

Folk remedies

The healing of purulent wounds during the regeneration phase can be accelerated by various herbs and other home remedies. They are used both to treat the affected surface and to strengthen the immune system. Most often, there are frivolous purulent wounds. Home treatment is possible if the inflammation is small and there is no general intoxication. Often folk remedies are used in medical institutions, due to the fact that many bacteria have developed resistance to drugs, moreover, they are safer. But their use is permissible only in mild cases, with a small lesion area. How can you treat a wound?

The most commonly used alcoholic tincture or calendula.

Treat the wound with fresh juice of aloe, plantain leaves or burdock.

For lotions, you can use gruel from grated carrots, radishes, beets, or a cut onion.

You can prepare an ointment for the healing of purulent wounds: mix powder from stonecrop herb with petroleum jelly or honey with lard and xeroform. A mixture of goat fat, salt and grated onions cleans the wound well from pus.

To improve tissue regeneration during wound healing, fish oil and sea buckthorn oil are used.

Complications from purulent wounds

If you do not start treatment on time or improperly treat the affected area, complications may develop, or the purulent process becomes chronic. Why are purulent wounds dangerous?

Lymphangitis or lymphadenitis may develop, that is, inflammation of the lymph nodes.

Sometimes thrombophlebitis appears, especially with purulent wounds on the legs.

Pus can spread and cause periostatitis, osteomelitis, abscess, or phlegmon.

In the most severe cases, sepsis develops, which can be fatal.

Prevention of inflammation

To prevent the appearance of purulent wounds, you need to carefully follow the rules of personal hygiene, especially if the skin is damaged. If you treat minor abrasions and scratches in time, you can protect them from infection. In addition, it is necessary to strengthen the immune system so that the body can independently fight bacteria that have got under the skin.

LESSON PLAN № 19


date according to the calendar-thematic plan

Groups: General Medicine

Number of hours: 2

Topic of the lesson:

Type of training session: a lesson in learning new teaching material

Type of training session: lecture

The goals of training, development and education: To form knowledge about the types of wounds, the clinical course of the wound process, the rules for providing PMP in case of injuries, the principles of wound treatment, depending on the phase of the wound process.

Formation: knowledge on issues:

1. Wounds. Classification of wounds.

Development: independent thinking, imagination, memory, attention,student speech (enrichment of vocabulary of words and professional terms)

Upbringing: feelings and personality traits (ideological, moral, aesthetic, labor).

SOFTWARE REQUIREMENTS:

As a result of mastering the educational material, students should know: Types of wounds, general and local signs of wound suppuration, rules for providing PMP for wounds, principles of treatment depending on the phase of the wound process;indications for emergency prevention of tetanus and rabies.

Material and technical support of the training session: dressing material, a set of tools for PHO, removal of stitches,presentation, situational tasks, tests

PROCESS OF THE LESSON

1. Organizational and educational moment: checking the attendance to classes, appearance, protective equipment, clothing, familiarization with the lesson plan - 5 minutes .

2. Acquaintance with the topic, questions (see below the text of the lecture), setting educational goals and objectives - 5 minutes:

4. Presentation of new material (conversation) - 50 minutes

5. Securing the material - 8 minutes:

6. Reflection: control questions on the material presented, difficulties in understanding it - 10 minutes .

2. Interviewing students on the previous topic - 10 minutes .

7. Assignment at home - 2 minutes . Total: 90 minutes.

Home assignment: pp. 93-99 pp. 198-217

Literature:

1. Kolb L.I., Leonovich S.I., Yaromich I.V. General surgery. - Minsk: Higher school, 2008.

2. Gritsuk I.R. Surgery. - Minsk: "Novoe znanie" LLC, 2004 year

3. Dmitrieva ZV, Koshelev A.A., Teplova A.I. Surgery with the basics of resuscitation. - St. Petersburg: Parity, 2002 year

4.L.I.Kolb, S.I. Leonovich, E.L. Kolb Nursing in surgery, Minsk, Higher School, 2007

5. Order of the Ministry of Health of the Republic of Bashkortostan No. 109 "Hygienic requirements for the structure, equipment and maintenance of healthcare organizations and for the implementation of sanitary-hygienic and anti-epidemic measures for the prevention of infectious diseases in healthcare organizations.

6. Order of the Ministry of Health of the Republic of Belarus No. 165 "On disinfection, sterilization by healthcare institutions

Teacher: L.G. Lagodich

LECTURE TEXT

Theme:Open mechanical damage (wounds)

Questions:

1. Wounds. Classification of wounds.

2. Phases of the wound process, clinical manifestations.

3. General and local signs of wound suppuration. Types of wound healing.

4. PMP for wounds. Principles of wound treatment depending on the phase of the wound process. Prevention of anaerobic infection.

5. Peculiarities of treatment of stab and bite wounds. Emergency tetanus prophylaxis, rabies prophylaxis.


1. Wounds. Classification of wounds.

Wound (vulnus) - mechanical damage to tissues or organs, accompanied by a violation of the integrity of their integuments or mucous membranes.

It is the violation of the integrity of the integumentary tissues (skin, mucous membrane) that distinguishes wounds from other types of damage (contusion, rupture, stretching). For example, a rupture of the lung tissue caused by blunt trauma to the chest is considered a rupture, and in the case of damage with a knife - a lung wound, because there is a violation of the integrity of the skin.

It is necessary to distinguish between the concept of "wound" and "injury". In essence, a wound is the end result of tissue damage. The concept of injury (vulneratio) is understood as the process of damage itself, the entire complex and multifaceted set of pathological changes that inevitably arise during the interaction of tissues and a wounding projectile both in the area of ​​damage and throughout the body. However, in everyday practice, the terms wound and injury are often used interchangeably and are often used interchangeably.

The main signs of a wound

The main classic signs of wounds are:

Pain;

Bleeding;

Hiatus;

Violation of tissue integrity;

Functional impairment.

The severity of each sign is determined by the nature of the injury, the volume of damaged tissues, the peculiarities of the innervation and blood supply of the wound canal zone, the possibility of injury to vital organs.

Elements of any wound are:

Wound cavity (wound channel);

Walls;

The bottom of the wound.

A wound cavity (cavum vulnerale) is a space bounded by the walls and bottom of the wound. If the depth of the wound cavity significantly exceeds its transverse dimensions, then it is called a wound channel (canalis vulneralis).

Wounds are classified on various grounds.

1. By the nature of tissue damage:

Puncture wounds applied with a piercing weapon (bayonet, needle, etc.). Their anatomical feature is their considerable depth with little damage to the integument. With these wounds, there is always a risk of damage to vital structures located deep in the tissues, in the cavities (vessels, nerves, hollow and parenchymal organs). Appearance and presentation of puncture wounds Does not always provide sufficient data for a diagnosis. So, with a puncture wound of the abdomen, it is possible to injure the intestine or the Liver, but the discharge of intestinal contents or blood from the wound usually cannot be detected. With a puncture wound, in an area with a large array of muscles, a large artery may be damaged, but external bleeding may also be absent due to muscle contraction and displacement of the wound canal. An interstitial hematoma is formed with the subsequent development of a false aneurysm.

Puncture wounds are dangerous because, due to the small number of symptoms, damage to deep-lying tissues and organs can be seen, therefore, a particularly careful examination of the patient's wound is also necessary by the fact that microorganisms are introduced into the depths of the tissues with a wounding weapon, and the wound discharge, without finding a way out, serves as a good breeding ground for them, which creates especially favorable conditions for the development of purulent complications.

Cut wounds applied with a sharp object. They are characterized by a small number of destroyed cells; the surrounding letters are not damaged. The gaping of the wound allows you to inspect the damaged tissue and creates good conditions for the outflow of the discharge. With a cut wound, there are the most favorable conditions for healing, therefore, when treating any fresh wounds, they tend to turn them into cut wounds.


Chopped wounds applied with a heavy sharp object (checker, ax, etc.). Such wounds are characterized by deep tissue damage, wide gaping, bruising and concussion of the surrounding tissues, which reduces their resistance and regenerative abilities.

Bruised and lacerated wounds (crushed) are the result of exposure to a blunt object. They are characterized by a large number of crushed, bruised, blood-soaked tissues with impaired vitality. Bruised blood vessels often rhombus. In bruised wounds, favorable conditions are created for the development of infection.

Scalped woundstangent to the surface of the body of the wound inflicted with a sharp cutting object. If at the same time the flap remains on the leg, then such a wound is calledpatchwork.

Bitten wounds are characterized not so much by extensive and deep damage as by severe infection with the virulent flora of the human or animal mouth. The course of these wounds is more often than others complicated by the development of an acute infection. Bite wounds can be contaminated with the rabies virus.

Poisoned wounds - these are wounds into which poison gets into (with the bite of a snake, scorpion, penetration of toxic substances), etc.


Gunshot wounds - special among the wounds. They differ from all others in the nature of the wounding weapon (bullet, splinter); the complexity of the anatomical characteristics; a feature of tissue damage with areas of complete destruction, necrosis and molecular concussion; a high degree of infection; a variety of characteristics (through, blind, tangent, etc.).

I distinguish the following elements of a gunshot wound:

-input(smaller) and the weekend(more) holes;

- wound channel area - area of ​​direct impact of a traumatic projectile; In the area of ​​the wound channel, there are:

- bruised area- area of ​​primary traumatic necrosis;

- molecular shock zone- area of ​​secondary necrosis;

A special approach in the treatment of such wounds, and, moreover, very different in peacetime and in wartime, at the stages of medical evacuation.

2. Due to damage to the wound divided into:

Operating (intentional);

Random.

3. By infection secrete wounds aseptic, freshly infected and purulent.



Purulent wound (burn) with areas of necrosis

4. In relation to body cavities (cavities of the skull, chest, abdomen, joints, etc.) are distinguished:

- penetrating wounds- penetrate into cavities with damage to the membranes of these cavities (meninges in the skull, pleura - in the chest, peritoneum - in the abdomen, synovium and bursa of joints). They pose a great danger due to the possibility of damage or involvement in the inflammatory process of the membranes, cavities and organs located in them.

- non-penetrating, respectively.

5. Allocate simple and complicated wounds , in which there is any additional tissue damage (poisoning, burns) or a combination of soft tissue injuries with damage to bone, hollow organs, etc.

2. Phases of the wound process, clinical manifestations.

The course of the wound process

The development of changes in the wound is determined by the processes occurring in it and the general reaction of the body. In any wound, there are dying tissues, hemorrhage and lymphatic effusion. In addition, a certain amount of microbes gets into wounds, even if they are clean, operating rooms.

During the healing of wounds, the resorption of dead cells, blood, lymph occurs and, due to the inflammatory reaction, the process of cleansing the wound is carried out. The wound walls close to each other are glued together (primary gluing). Along with these processes in the wound, connective tissue cells multiply, which undergo a number of transformations and turn into fibrous connective tissue - a scar. On both sides of the wound, there are opposite processes of neoplasm of blood vessels, which grow into a fibrin clot that sticks together the walls of the wound. Simultaneously with the formation of a scar and blood vessels, the epithelium multiplies, the cells of which grow on both sides of the wound and gradually cover the scar with a thin layer of the epidermis; in the future, the entire layer of the epithelium is completely restored.

Of great importance is the division of the course of the wound process into three phases, determined on the basis of the study of morphological, biochemical changes, the type of exudate, the state of the wound and the severity of the clinical picture.

They are morphologically distinguished:

First phase (hydration phase) - occurs immediately after injury and lasts for several days (3-4). During this time, inflammation develops with all its classic signs, see above.

The second phase (dehydration phase) - the phase corresponds to the period of extinction of inflammation and cleansing of the wound, lasts 2-3 weeks

Third phase (regeneration phase) - characterized by the predominance of restorative, regenerative processes.

The regeneration phase, in turn, consists of:

STAGE OF GRANULATION, - in the cleared wound, granulation tissue begins to grow violently (photo on the left), filling the entire wound cavity.

STAGE OF EPITHELIZATION, - the growth of the epithelium goes along the periphery of the wound, gradually narrowing it, reducing its area (the same photo on the left). Epithelialization of a granulating wound begins from the first days. The epithelium, multiplying, grows on the granulation tissue. If it is young, with well-developed vessels, then epithelialization is strong. If the granulations are covered with necrotic cells or rough fibrous tissue has already formed, then the epithelium, growing, dies and epithelialization is delayed, long-term non-healing wounds and ulcerating scars are formed.

Granulation tissue is a barrier that separates the internal environment of the body from external influences. The wound discharge covering the granulation has pronounced bactericidal properties. Granulation tissue consists of very easily vulnerable cells and vessels, therefore even a weak mechanical or chemical injury (rubbing with gauze, dressing with a hypertonic solution, etc.) damages it. Such a violation of the integrity of the granulation tissue opens the entrance gate for microbes.

3. General and local signs of wound suppuration. Types of wound healing.

Signs of suppuration of wounds correspond to the classic signs of inflammation as a biological reaction of the body to a foreign agent:

Dolor (pain);

Calor (temperature);

Tumor (swelling, edema);

Rubor (redness);

Functio lesae (dysfunction);

Thus:

Types of wound healing:

Healing primary intention- fusion of the edges of the wound without visible cicatricial changes;

Healing secondary tension- healing through suppuration;

- healing under the scab - under the formed crust, which should not be removed prematurely, further injuring the wound.

Distinguish three main stage wound healing:

Resorption of dead cells, tissues and hemorrhages;

Development of granulations filling the tissue defect resulting from their death;

Scar formation from granulation tissue.

4. PMP for wounds. Principles of wound treatment depending on the phase of the wound process. Prevention of anaerobic infection.

Principles of wound healing are built taking into account the biological processes taking place in the wound. Therapeutic measures should improve the regeneration processes and create unfavorable conditions for the development of microorganisms in the wound. The complex of therapeutic measures includes funds that act locally on the wound, and general ones that act on the entire body. Both those and others should contribute to improving the conditions of the natural course of the wound process. They should be different for fresh and purulent wounds, in different phases of the course of the wound process, as well as with different severity of the process.

The general objectives of wound healing are:

1) the ability to anticipate and prevent the dangers of injury;

2) a decrease in the number and virulence of the infection;

3) removal of dead tissue;

4) strengthening of regeneration processes.

Any wound is characterized by the presence of infection, and after 2-3 days - by the presence of pus, tissue necrosis, the development of microbes, tissue edema, absorption of toxins.

Treatment objectives: removal of pus and necrotic tissue; reduction of edema and exudation; fight against microorganisms.

Clinical phases of the course of the wound process:

Inflammation;

Regeneration:

Epithelialization.

All therapeutic measures are carried out in strict accordance with the stages of the wound process. Each stage has its own treatment objectives, as well as ways to achieve them.

Primary surgical debridement of wounds (PCO):The video is shown upon admission of the patient,usually under local anesthesia.

PHO stages:

1. Inspection of the wound, toilet of the skin edges, their treatment with aetiseptic (tincture of iodine 5%, do not get into the wound);

2. Revision of the wound, excision of all non-viable tissues, removal of foreign bodies, small fragments of bones, dissection of the wound, if necessary, to eliminate pockets;

3. About final stop of bleeding;

3. Drainage of the wound, according to indications;

4. Primary wound suture (according to indications);

INFLAMMATION

The stage is characterized by the presence of all signs of a purulent wound process. In a purulent wound, there are remnants of non-viable and dead tissue of its own, foreign objects, dirt, accumulation of pus in cavities and folds. Viable tissues are edematous. There is an active absorption of all this and microbial toxins from the wound, which causes the phenomena of general intoxication: an increase in body temperature, weakness, headache, lack of appetite, etc. Treatment of purulent wounds

Stage treatment objectives : drainage of the wound to remove pus, necrotic tissue and toxins; fighting infection. Wound drainage can be active (using devices for aspiration) and passive (drainage tubes, rubber strips, gauze wipes and turundas moistened with water-salt solutions of antiseptics.

Hypertonic solutions:

The most commonly used by surgeons is a 10% sodium chloride solution (the so-called hypertonic solution). Besides him, there are other hypertonic solutions: 3-5% boric acid solution, 20% sugar solution, 30% urea solution, etc. Hypertonic solutions are designed to ensure the outflow of wound discharge. However, it was found that their osmotic activity lasts no more than 4-8 hours, after which they are diluted with wound secretion, and the outflow stops. Therefore, recently, surgeons refuse to use a hypertonic solution.

Ointments:

In surgery, various ointments are used on a fatty and petrolatum base; Vishnevsky ointment, synthomycin emulsion, ointments with a / b - tetracycline, neomycin, etc. But such ointments are hydrophobic, that is, they do not absorb moisture. As a result, tampons with these ointments do not provide an outflow of wound secretions, they become only a cork. At the same time, the antibiotics present in the ointments are not released from the ointment compositions and do not have a sufficient antimicrobial effect.

Pathogenetically justified the use of new hydrophilic water-soluble ointments - Levosin, Levomikol, mafenide-acetate. Such ointments contain antibiotics, which are easily transferred from the composition of the ointments to the wound. The osmotic activity of these ointments exceeds the effect of a hypertonic solution by 10-15 times, and lasts for 20-24 hours, therefore, one dressing per day is enough for an effective effect on the wound.

Enzyme therapy (enzyme therapy):

For the speedy removal of dead tissue, necrolytic drugs are used. Proteolytic enzymes are widely used - trypsin, chymopsin, chymotrypsin, terrilitin. These drugs cause lysis of necrotic tissue and accelerate wound healing. However, these enzymes also have disadvantages: in the wound, enzymes retain their activity for no more than 4-6 hours. Therefore, for effective treatment of purulent wounds, the dressings must be changed 4-5 times a day, which is almost impossible. It is possible to eliminate such a lack of enzymes by including them in ointments. So, Iruksol ointment (Yugoslavia) contains the enzyme pentidase and the antiseptic chloramphenicol. The duration of enzyme action can be increased by immobilizing them in dressings. So, trypsin immobilized on napkins acts for 24-48 hours. Therefore, one dressing per day fully provides a therapeutic effect.

Use of antiseptic solutions.

Solutions of furacillin, hydrogen peroxide, boric acid, etc. are widely used. It has been established that these antiseptics do not have sufficient antibacterial activity against the most frequent causative agents of surgical infection.

Among the new antiseptics, it should be noted: iodopyrone, a preparation containing iodine, is used for treating the hands of surgeons (0.1%) and treating wounds (0.5-1%); dioxidine 0.1-1%, sodium hypochlorite solution.

Physical treatments.

In the first phase of the wound process, quartzing of wounds, ultrasonic cavitation of purulent cavities, UHF, hyperbaric oxygenation are used.

Laser application.

In the phase of inflammation of the wound process, high-energy, or surgical, laser is used. With a moderately defocused beam of a surgical laser, pus and necrotic tissues are evaporated, thus it is possible to achieve complete sterility of wounds, which in some cases makes it possible to impose a primary suture on the wound.

REGENERATION

The stage is characterized by complete cleansing of the wound and the execution of the wound cavity with granulations (tissue of bright pink color with a granular structure). It first performs the bottom of the wound, and then fills the entire wound cavity. At this stage, its growth should be stopped.

Stage objectives: anti-inflammatory treatment, protection of granulations from damage, stimulation of regeneration

These tasks are answered by:

a) ointments: methyluracilic, troxevasinic - to stimulate regeneration; fat-based ointments - to protect granulations from damage; water-soluble ointments - anti-inflammatory effect and protection of wounds from secondary infection.

b) herbal preparations - aloe juice, sea buckthorn and rosehip oil, Kalanchoe.

c) the use of a laser - in this phase of the wound process, low-energy (therapeutic) lasers with a stimulating effect are used.

EPITHELIZATION

The stage occurs after the completion of the bottom of the wound and its cavity with granulation tissue (see figure). Stage objectives: to speed up the process of epithelialization and scarring of wounds. For this purpose, sea buckthorn and rosehip oil, aerosols, troxevasin-jelly, low-energy laser irradiation are used. At this stage, the use of ointments that stimulate the growth of granulations is not recommended. On the contrary, it is recommended to switch back to water-salt antiseptics. It is helpful to allow the dressing to dry to the wound surface. In the future, it should not be torn off, but only cut off along the edges, as it detaches due to the epithelialization of the wound. From above, it is recommended to moisten such a bandage with iodonate or other antiseptic. In this way, the healing of a small wound under the scab is achieved with a very good cosmetic effect. In this case, a scar is not formed.

With extensive skin defects, long-term non-healing wounds and ulcers in the 2nd and 3rd phases of the wound process, i.e. after cleansing the wounds from pus and the appearance of granulations, dermoplasty can be performed:

a) artificial leather

b) a split displaced flap

c) walking stem according to Filatov

d) autodermoplasty with a full-thickness flap

e) free autodermoplasty with a thin-layer flap according to Thirsh

At all stages of the treatment of purulent wounds, one should remember about the state of immunity and the need to stimulate it in patients of this category.

Factors contributing to wound healing:

General condition of the body;

The nutritional status of the body;

Age;

Hormonal background;

Development of wound infection;

Oxygen supply condition;

Dehydration;

Immune status.

Stages of wound dressing:

1. Removing the old bandage;

2. Inspection of the wound and surrounding area;

3. Toilet of the skin surrounding the wound;

4. Toilet of the wound;

5. Manipulation of the wound and preparing it for the imposition of a new bandage;

6. Applying a new bandage;

7. Fixation of the bandage (see section Desmurgy)

5. Peculiarities of treatment of stab and bite wounds. Emergency tetanus prophylaxis, rabies prophylaxis.

A feature of a puncture wound is a small entrance opening and a deep wound channel. What does it mean? This means that an infection, especially anaerobic one, immediately falls into optimal conditions for its development. This is a dangerously formidable complication of the wound process - gas gangrene.The peculiarity of the treatment is a wide dissection of the wound and drainage.

Features of a bitten wound: a wound with ragged sagged edges, deep punctures with teeth and infection with a serious infection that is always in the mouth, trauma to the soft tissues of the jaws. All this provides almost 100% suppuration and various complications of the wound process (tetanus, rabies). OSobennosti treatment: thorough primary surgical treatment of wounds, rinsing first with warm water and soap, then antiseptics and high-quality drainage. The wounds are not sewn up! Necessarily - resolving the issue of emergency immunoprophylaxis of rabies

Prevention of anaerobic infection.

Tetanus is a fatal disease that belongs to the class of anaerobic infections. Therefore, the only way to fight is to prevent tetanus. It starts from childhood in several stages. AC drugs, DPT vaccines, ADS, etc. Our child is considered to be primarily vaccinated. Revaccination of adults is prescribed for life once every 10 years. But who of the adults does it.

Anaerobic infection is a specific surgical infection caused by Clostridia. The specified type of microbes belongs to anaerobes. They are widely distributed in nature, especially in soil, intestines of animals and humans.They cause a severe complication of the wound process in the form of gas gangrene.Therefore, the wounds most dangerous in relation to gas gangrene are deep wounds contaminated with soil, with massive damage to soft tissues.

Prevention:

1. Early adequate surgical treatment of open lesions, wide drainage of the wound with tubular drains and flow lavage (continuous or fractional) with solutions that give off oxygen (oxidants: potassium permanganate, hydrogen peroxide). Immobilization.

2. Introduction of large doses of antibiotics: thienam (1.5-2.0 g per day), penicillin (3-5 million units 6 times a day), semi-synthetic penicillins (ampicillin, oxacillin, ampiox - up to 6-8 g .); lincomycin (1.8 - 2.0 g).

3. Introduction of polyvalent antigangrenous serum, prophylactic dose of 30 thousand IU (10 thousand units against Cl. Perfringens, Cl. Novi, Cl. Septicum).

4. Anaerobic bacteriophage 100 ml. diluted with 100 ml. 0.5% novocaine solution, tissue infiltration around the wound is performed.

Emergency tetanus prophylaxis, rabies prophylaxis.

Tetanus.

Routine immunization

Emergency tetanus prophylaxis is regulated: regulatory document - see below

Rabies.

Emergency rabies prophylaxis, its schemes are prescribed depending on:

1. Bite sites: Head and finger bites are considered severe;

2. The bite is provoked or not. An unprovoked bite is suspicious of rabies;

3. Animal known or not, healthy, died, disappeared, killed. In case of impossibility of veterinary control over the animal, vaccinations against rabies are prescribed unconditionally;

Doctors call such wounds of the skin and adjacent tissues as purulent, in which there is an accumulation of pus, there is swelling and tissue death, as a result of which toxins are absorbed by the body in the wound cavity.

The development of suppuration in the affected area is caused by its infection or by the breakthrough of the abscess.

Doctors call the invariable companions of purulent wounds severe edema in the affected area, hyperemia of adjacent tissues and severe pain syndrome. Severe pain, up to and including deprivation of sleep, can be twitching or bursting.

In the affected area, accumulations of pus and necrotic tissue are visible. Absorption of toxins, as well as decay products, occurs, which causes general intoxication of the body, associated with an increase in temperature, severe headaches, chills, weakness and nausea.

Depending on which process prevails, doctors identified 3 stages of the suppuration process:

  1. maturation of the focus of pus in the affected area,
  2. cleansing the affected area and regenerative processes in the tissues,
  3. healing.

Healing of all pus wounds is carried out by secondary intention.

  • opening of purulent streaks (if found),
  • thorough washing and drainage of the affected area,
  • drug therapy using antibacterial and immunostimulating drugs,
  • the imposition of special antiseptic dressings,
  • detoxification,
  • drug stimulation of the body's launching natural recovery processes.

Causes

Medical evidence suggests that absolutely any wound received at random already contains bacteria that penetrate the wound at the time of its receipt. This means that any accidental wound is infected. At the same time, not every wound with bacterial contamination develops a purulent process.

For the decay process to arise, there must be a simultaneous presence of adverse factors:

  • Sufficient cavity of tissue damage.
  • A sufficient level of concentration in the wound cavity of the bodies of pathogenic microbes.

Experimental data showed that to start the process of suppuration in healthy tissues, there must be 100 thousand microbial bodies per 1 gram of them. In turn, the critical concentration of infection can decrease under unfavorable conditions.

If dirt, foreign bodies or coagulated blood gets into the wound, the presence of 10 thousand microorganisms per gram of tissue is enough for the development of a purulent process.

In the case of ligature ischemia, which is caused by difficulties in tissue nutrition in the zone of tying the ligature, the critical level is reduced to only one thousand bodies of pathogenic microbes per gram of tissue.

In 90% of pus wounds, doctors find pus-producing bacteria. The most commonly detected streptococcus, Klebsiella, Escherichia coli, Proteus, Staphylococcus aureus and Pseudomonas.

Also, a purulent process can be triggered by pneumococci, shigella, salmonella, mycobacteria and other pathogenic flora.

Presence of coagulated blood, necrosis and impurities in the cavity.

Purulent wounds of a torn-bruised, stabbed and associated with crushing of soft tissues of character often become purulent.

The main reason for the occurrence of suppuration in puncture wounds is the poor outflow of fluid from the wound due to the fact that the wound channel is relatively thin and long, and the opening on the skin surface is small.

A high percentage of complications by the processes of suppuration of lacerated-bruised wounds and wounds associated with crushing of soft tissues is due to severe pollution and / or a significant amount of non-viable tissues.

Less often than others, cut wounds fester. This is due to the fact that their edges are slightly damaged, and the wound channel has a shallow depth.

Other factors that increase the risk of a suppuration process are:

Health status, diabetes mellitus, vascular disorders and a number of somatic diseases.

In the case of an insignificant bacterial infection, high immunity reduces the risk of suppuration in the damaged cavity.

In the case of significant bacterial insemination and normal immunity, the purulent process, as a rule, has a more violent course, but at the same time it is sufficiently localized and ends with a rather rapid recovery.

Disturbances in the immune system entail a sluggish course of suppuration and a long healing of a purulent wound, while the risk of complications and the spread of infection increases many times over.

Somatic diseases negatively affect the state of immunity and health in general, as a result of which the likelihood of suppuration increases, and wound healing proceeds more slowly.

The most dangerous disease against which a purulent wound can develop is diabetes mellitus. Even with a small lesion and a slight bacterial infection, strong suppuration can develop, and in patients with diabetes mellitus there is a pronounced tendency for this process to spread.

  • The age and weight of the patient. According to statistics, in young people, the process of festering in wounds develops less often than in old people. Overweight patients are more likely to suffer from purulent wounds than thin people.
  • Season. The risk of the occurrence of purulent processes in the wound cavity in the warm season increases, especially the humid and hot climate is negatively reflected. In this regard, doctors are trying to prescribe scheduled non-urgent operations for the cold season.
  • The type of wound and its location. The least susceptible to suppuration are lesions in the cervical spine and head region. Wounds to the back, buttocks, abdomen and chest are more susceptible to suppuration. Injuries to the extremities are most often associated with suppuration, and suppuration is especially difficult in the area of ​​the feet.

Symptoms

Symptoms of purulent wounds are divided into general and local.

Local symptoms of purulent wounds:

  • The presence of purulent exudate and a visually visible defect in the skin and tissues.
  • The main sign of a purulent wound is, in fact, pus.
  • The amount of pus in the wound can be different; under it, in advanced cases, there may be granulations and areas of necrotic tissue.

Depending on what was the causative agent of suppuration, the consistency and shade of pus varies.

  • Pseudomonas aeruginosa is characterized by yellowish pus, which is blue-green on the bandage (upon contact with air, the pus changes color).
  • Anaerobic microbes - fetid brown.
  • Streptococcus is watery yellowish or greenish.
  • Escherichia coli - liquidish brown-yellow.
  • Staphylococcus aureus provokes the development of thick white or yellow pus.

When suppuration forms in the wound, pressing and bursting pain is characteristic. When the outflow of pus is difficult due to the fact that a crust has formed, streaks have formed or the purulent process has spread, increased production of pus and inflammation of the affected area begins. As a result of the increase in pressure in the wound cavity, a twitching pain appears, so strong that it can deprive a person of sleep.

Local hyperemia. The skin around the wound becomes hot. At the initial stage, when pus is formed, reddening of the skin is visible.

In the event that the wound is running, the adjacent skin can change from a reddish tint to a purple one or become purple-cyanotic.

  • Local increase in temperature.
  • Swelling of adjacent tissues.

In the affected area, there are two types of edema. A warm, inflammatory edema is usually located along the edges of the wound, coinciding with the area of ​​hyperemia. Its appearance is caused by impaired blood flow in the affected area.

Violation of physiological functions. Decreased function of the affected area is mainly associated with swelling and intense pain. The degree of their severity depends on the phase and volume of the inflammatory process, as well as on the location and size of the wound,

General symptoms of purulent wounds

Toxins are released from a purulent wound into the patient's body, which entails a general intoxication of the body.

Symptoms that are characteristic of suppuration in the wound cavity:

  • increase in body t
  • weakness, in advanced cases, the patient may lose consciousness and fall into a coma
  • high sweating
  • decreased or absolute loss of appetite
  • chills
  • headache
  • specific results of clinical tests. In the analysis of blood, the presence of leukocytosis with a shift to the left is characteristic, as well as an acceleration of ESR. In urine tests, as a rule, an increased protein is noted.

In advanced situations, an increase in the level of creatinine, urea and bilirubin is observed in the blood. There is a high probability of developing anemia, dysproteinemia, hypoproteinemia and leukopenia.

Complications

Pus in a wound can lead to a number of serious complications.

Inflammation of the lymphatic vessels, which are located proximal to the affected area, up to lymphangitis, may develop. Inflammation is visually manifested by the appearance of red stripes that are directed from the wound to the regional lymph nodes. In the case of the development of lymphadenitis, the regional lymph nodes increase in size and become painful.

In advanced cases, purulent wounds can provoke the onset of thrombophlebitis, this disease causes the appearance of very painful scarlet cords in the direction of the saphenous veins.

If purulent fluids have spread in contact, purulent streaks, periostitis, abscesses, purulent arthritis, phlegmon and osteomyelitis may develop.

The most negative consequence of wound suppuration can be sepsis.

In that situation, if the required medical measures were not taken on time and the healing process does not begin for a long time, a purulent wound can become chronic.

Western doctors classify them as chronic wounds that show no tendency to heal for a month or more. Traditionally, these include:

  • trophic ulcers;
  • wounds, both operating and accidental, that do not heal for a long time;
  • bedsores.

Treatment

Most often, the diagnosis of purulent wounds does not consist in making such a diagnosis - suppuration in the wound is clearly visible even to a non-specialist, but in establishing the nature of the flora that provoked the suppuration and the level of infection.

In order to find out the nuances of infection, doctors resort to general clinical and biochemical studies, and a microbiological study of exudate from the wound is also carried out.

Reliable determination of the nature of the infection helps to choose the most effective antibacterial drugs.

The tactics of treating wounds in which a purulent process develops includes:

  • Antibacterial therapy. Medicinal antibacterial drugs are prescribed without fail, the selection of the most effective drugs is carried out based on the external characteristics of pus (if it is impossible to conduct analyzes) or data from microbiological studies of the contents of a purulent wound.
  • Detoxification therapy. It is designed to ensure the active elimination of toxins from the body. To reduce intoxication, doctors use the methods of forced diuresis, infusion therapy, hardware detoxification (hemosorption, plasmapheresis, hemodialysis). The main recommendation for reducing the level of intoxication of the body at home is drinking plenty of fluids.
  • Immunostimulating therapy. Its purpose is to increase the body's resistance and stimulate the production of natural interferon and tissue protective factors.

The surgeon deals with the treatment, the doctor determines the tactics of its conduct, taking into account the phase of the wound process.

At the stage of the formation of a purulent focus, the main task of the surgeon is to cleanse the wound as completely as possible, reduce the inflammatory process, combat pathogenic flora and, if there are medical indications, reduce intoxication.

At the second stage, doctors carry out manipulations designed to stimulate regenerative processes, it becomes possible to impose early secondary sutures or perform plastic surgery of the skin.

As long as pus continues to form in the wound, suturing is unacceptable, only rare sutures are possible in order to organize flow-washing drainage.

At the stage of wound closure, measures are taken to stimulate the formation of new epithelial cells in the affected area.

In the event that the formation of pus begins again in the cavity, additional surgical treatment is performed, during which the edges of the wound or skin are cut over the place of its accumulation and its removal is performed.

The wound is examined to identify leaks of pus and, if found, an autopsy of these leaks is carried out. Pus and necrosis are removed, bleeding stops, the wound is thoroughly washed and then drained.

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