PSO is the first surgical operation performed on a patient with a wound under aseptic conditions, with anesthesia and consisting of the sequential implementation of the following steps:
1) dissection
2) revision
3) excision of the edges of the wound within apparently healthy tissues, walls and bottom of the wound
4) removal of hematomas and foreign bodies
5) restoration of damaged structures
6) if possible, suturing.
The following options for suturing wounds are possible: 1) layer-by-layer suturing of the wound tightly (for small wounds, lightly contaminated, when localized on the face, neck, torso, with a short period from the moment of injury)
2) suturing the wound leaving drainage
3) the wound is not sutured (this is done if there is a high risk of infectious complications: late PSO, heavy contamination, massive tissue damage, concomitant diseases, elderly age, localization on the foot or lower leg)
Types of PHO:
1) Early (up to 24 hours from the moment the wound is inflicted) includes all stages and usually ends with the application of primary sutures.
2) Delayed (from 24-48 hours). During this period, inflammation develops, swelling and exudate appear. The difference from early PSO is that the operation is performed while antibiotics are administered and the intervention is completed by leaving it open (not sutured) with the subsequent application of primary delayed sutures.
3) Late (later than 48 hours). Inflammation is close to maximum and the development of the infectious process begins. In this situation, the wound is left open and a course of antibiotic therapy is given. It is possible to apply early secondary sutures on days 7-20.
PHO are not subject to the following types wound:
1) superficial, scratches
2) small wounds with edge separation of less than 1 cm
3) multiple small wounds without damage to deeper tissues
4) puncture wounds without organ damage
5) in some cases, through bullet wounds of soft tissues
Contraindications to performing PSO:
1) signs of development of a purulent process in the wound
2) critical condition of the patient
Types of seams:
Primary surgical Apply to the wound before granulation begins to develop. Apply immediately after completion of the operation or PSO wounds. It is not advisable to use in late PHO, PHO in wartime, PHO of a gunshot wound.
primary deferred Apply until granulation develops. Technique: the wound is not sutured after the operation, the inflammatory process is controlled and when it subsides, this suture is applied for 1-5 days.
secondary early Apply to granulating wounds that heal by secondary intention. The application is carried out for 6-21 days. By 3 weeks after surgery, scar tissue forms at the edges of the wound, preventing both the approximation of the edges and the process of fusion. Therefore, when applying early secondary sutures (before the edges become scarred), it is enough to simply stitch the edges of the wound and bring them together by tying the threads.
secondary late Apply after 21 days. When applying, it is necessary to excise the scarred edges of the wound under aseptic conditions, and only then apply sutures.
13. Toilet wounds. Secondary surgical treatment of wounds.
Toilet wound:
1) removal of purulent exudate
2) removal of clots and hematomas
3) cleansing the wound surface and skin
Indications for VCO are the presence of a purulent focus, lack of adequate outflow from the wound, the formation of large areas of necrosis and purulent leaks.
1) excision of non-viable tissue
2) removal of foreign bodies and hematomas
3) opening pockets and leaks
4) wound drainage
Differences between PHO and VHO:
|
Signs | ||
|
Deadlines |
In the first 48-74 hours |
After 3 days or more |
|
Main purpose of the operation |
Prevention of suppuration |
Treatment of infection |
|
Condition of the wound |
Does not granulate and does not contain pus |
Granulates and contains pus |
|
Condition of excised tissues |
WITH indirect signs necrosis |
WITH obvious signs necrosis |
|
Cause of bleeding |
The wound itself and tissue dissection during surgery |
Arrosion of a vessel in conditions of a purulent process and damage during tissue dissection |
|
Character of the seam |
Closure with primary suture |
Subsequently, secondary sutures may be applied. |
|
Drainage |
According to indications |
Necessarily |
14. Classification by type of damaging agent : mechanical, chemical, thermal, radiation, gunshot, combined. Types of mechanical injuries:
1 – Closed (skin and mucous membranes are not damaged),
2 – Open (damage to mucous membranes and skin; risk of infection).
3 – Complicated; Immediate complications that occur at the time of injury or in the first hours after it: Bleeding, traumatic shock, disruption of vital organ functions.
Early complications develop in the first days after injury: Infectious complications (wound suppuration, pleurisy, peritonitis, sepsis, etc.), traumatic toxicosis.
Late complications are detected at a time distant from the injury: chronic purulent infection; violation of tissue trophism (trophic ulcers, contracture, etc.); anatomical and functional defects of damaged organs and tissues.
4 – Uncomplicated.
Every person from time to time faces such an unpleasant problem as wounds. They can be small or deep; in any case, the wounds require timely treatment and competent treatment, otherwise there is a risk of serious and even life-threatening complications.
Sometimes situations happen when earth gets into the wound, chemical substances, foreign objects, such situations require special actions, so each person needs to familiarize themselves with the rules of first aid for injuries. In addition, it has been proven that wounds that are treated in the first hour heal much faster than those that are treated later.
The wound is mechanical injury, in which the integrity of the skin, subcutaneous layers and mucous membranes is disrupted. The skin performs protective function in the human body, does not allow pathogenic bacteria, dirt, harmful substances to enter, and when its integrity is compromised, access harmful substances and germs into the wound opens.
The wound may provoke various complications, which may appear immediately after the injury or after some time, especially if the primary debridement wounds:
- Infection. This complication occurs quite often; it is caused by the proliferation of pathogenic microflora. The presence of a foreign object, damage to nerves, bones, tissue necrosis, and accumulation of blood contributes to the suppuration of the wound. Most often, the infection is associated with improper or untimely processing.
- Hematomas. If the bleeding is not stopped in time, a hematoma may form inside the wound. This condition is dangerous because it significantly increases the risk of infection, since blood clots are a favorable environment for bacteria. In addition, a hematoma can impair blood circulation in the affected area, which leads to tissue death.
- Traumatic shock. At severe injuries Severe pain and great blood loss may occur; if the person is not helped at this moment, he may even die.
- Magnelization. If a wound becomes chronic and goes untreated for a long time, there is every chance that one day the cells will begin to change and turn into a cancerous tumor.
If the infection in the wound is not treated in time, there is a high risk serious complications. Any, even the smallest suppuration, is a pathology that can lead to sepsis, phlegmon, gangrene. Such conditions are serious, require long-term and urgent treatment, and can cause death.
First aid
Any wound, small or large, requires urgent treatment to stop bleeding. If the injury is minor, it is enough to provide first aid to the victim and change the bandages regularly, but if the wound is large and bleeds heavily, then it is imperative to go to the hospital.
There are a number of basic rules that must be followed when performing PSO of a wound:
- Before the start of rendering medical care Hands should be washed well, it is advisable to wear sterile gloves, or treat the skin of your hands with an antiseptic.
- If there are small foreign objects in a small wound, they can be removed using tweezers, which are recommended to be washed with water and then with an antiseptic. If the object is deep, if it is a knife or something large, then you should not remove the object yourself, you need to call ambulance.
- You can only rinse with clean boiled water and an antiseptic solution; do not pour iodine or brilliant green into it.
- To apply a bandage, you need to use only a sterile bandage; if you need to cover the wound until the doctor arrives, you can use a clean diaper or handkerchief.
- Before bandaging a wound, you need to apply a napkin moistened with an antiseptic to it, otherwise the bandage will dry out.
- There is no need to bandage abrasions; they heal faster in the air.
First aid procedure:
- Small cuts and abrasions should be washed with boiled warm or running water; deep wounds should not be washed with water.
- To stop bleeding, you can apply cold to the sore spot.
- The next step is to wash the wound with an antiseptic solution, for example, hydrogen peroxide or chrogexidine. Peroxide is more suitable for initial treatment; it foams and pushes dirt particles out of the wound. For secondary treatment, it is better to use chlorhexidine, as it does not injure tissue.
- The edges of the wound are treated with brilliant green.
- On last stage A bandage is applied that needs to be changed regularly.
Treatment of a deep wound
It is very important to know how to properly treat a wound if it is deep. Severe injuries may result painful shock, severe bleeding and even death of a person. For this reason, assistance must be provided immediately. In addition, when deep wound it is necessary to take the victim to the hospital as soon as possible. The rules for providing first aid for a deep wound are as follows.
The main goal is to stop blood loss. If a large foreign object, such as a knife, remains in the wound, there is no need to remove it until doctors arrive, as it will control the bleeding. In addition, if the object is removed incorrectly, internal organs can be injured and cause the death of the victim.
If there are no foreign objects in the wound, it is necessary to press on it through a clean, or preferably sterile, cloth or gauze. The victim can do this independently. You need to put pressure on the wound until the doctors arrive, without letting go.
To stop severe bleeding from a limb, you need to apply a tourniquet above the wound. It should not be too tight, and it must be done correctly. The tourniquet is applied to clothing quickly and removed slowly. You can hold the tourniquet for an hour, after which you need to loosen it for 10 minutes and bandage it a little higher. It is very important to make a note on the patient’s clothing or body about the time the tourniquet was applied in order to remove it in time, otherwise there is a risk of causing tissue necrosis. There is no need to apply a tourniquet if the bleeding is light and can be stopped with a pressure bandage.
You need to pay attention to whether there are any symptoms of painful shock. If a person panics, screams, or makes sudden movements, then perhaps this is a sign of traumatic shock. In this case, after a few minutes the victim may lose consciousness. From the very first minutes it is necessary to lay the person down, slightly raise his legs and ensure silence, cover him, give him something to drink warm water or tea, if the oral cavity is not injured. It is necessary to inject the patient with painkillers as soon as possible to relieve the pain, and under no circumstances should he be allowed to go anywhere or get up.
If the victim has lost consciousness, do not give him pills, water or place any objects in the mouth. This may cause suffocation and death.
Medicines
It is very important to know how to treat a wound; antiseptics are always used for these purposes - these are special disinfectants that prevent and stop putrefactive processes in the tissues of the body. It is not recommended to use antibiotics to treat wounds, since they only kill bacteria, and the wound may have a fungal or mixed infection.
It is very important to use antiseptics correctly, since they do not promote rapid healing of the wound, but only disinfect it. If such medications are used incorrectly and uncontrollably, the wound will take a very long time to heal.
Let's look at some of the most popular antiseptics.
Hydrogen peroxide. This remedy is used for the initial treatment of wounds and for the treatment of suppuration; it is important to note that only a 3% solution is suitable for these purposes; a higher concentration can cause a burn. Peroxide cannot be used if a scar has appeared, as it will begin to corrode it and the healing process will be delayed. Peroxide should not be used to treat deep wounds; it should not be mixed with acid, alkali or penicillin.
Chlorhexidine. This substance is used both for primary treatment and for the treatment of suppuration. It is best to rinse the wound with peroxide before using chlorhexidine so that particles of dust and dirt are removed with the foam.
Ethanol. The most accessible and well-known antiseptic, it cannot be used on mucous membranes, but must be applied to the edges of the wound. For disinfection, you need to use alcohol from 40% to 70%. It is worth noting that alcohol cannot be used for large wounds, as it provokes severe pain and can cause painful shock.
Potassium permanganate solution. It should be made weak, slightly pink. Potassium permanganate is used for primary treatment and washing of suppuration.
Furacilin solution. You can prepare it yourself in the proportion of 1 tablet per 100 ml of water; first, it is better to crush the tablet into powder. The product can be used to wash mucous membranes and skin, to treat suppuration.
Zelenka and iodine Apply only to the edges of the wound. You should not use iodine if you are allergic to it or have problems with thyroid gland. If you apply these solutions to a wound or fresh scars, the injury will take longer to heal, since the substance will cause tissue burns.
Chlorhexidine, peroxide, furatsilin and potassium permanganate can be used to wet the napkin under the bandage so that the bandage does not stick to the wound.
PCP of wounds in children
I would like to pay special attention to PCP of wounds in children. Babies react violently to any pain, even to a small abrasion, so first of all the child needs to be seated or laid down and calmed down. If the wound is small and the bleeding is weak, it is washed with peroxide or treated with chlorhexidine, smeared around the edges with brilliant green and covered with an adhesive plaster.
In the process of providing first aid, you should not cause panic; you need to show the child that nothing bad has happened, and try to turn the whole process into a game. If the wound is large, there are foreign objects in it, then you need to call an ambulance as soon as possible. You should not remove anything from the wound, especially with dirty hands, this is very dangerous.
The child must be immobilized as much as possible and not allowed to touch the wound. At heavy bleeding When the blood spurts out, you need to apply a tourniquet. It is very important to get the child to the hospital as soon as possible and prevent large blood loss.
Video: PSW - primary surgical treatment of a wound
Treatment of fresh wounds begins with prevention wound infection, i.e. with carrying out all measures to prevent the development of infection.
Any accidental wound is primarily infected, because microorganisms in it multiply quickly and cause suppuration.
An accidental wound should be subjected to surgical debridement. Currently, surgery is used to treat accidental wounds.
method of treatment, i.e. primary surgical treatment of wounds. Any wound must be subjected to PSO of the wound.
Through PST of wounds, one of the following 2 problems can be solved (case number 3):
1. Transformation of a bacterially contaminated accidental or combat wound into an almost aseptic surgical wound (“sterilization of the wound with a knife”).
2. Transformation of a wound with a larger area of damage to surrounding tissues into a wound with a small area of damage, simpler in shape and less bacterially contaminated.
Surgical treatment of wounds is a surgical intervention consisting of a wide dissection of the wound, stopping bleeding, excision of non-viable tissue, removal of foreign bodies, free bone fragments, blood clots in order to prevent wound infection and create favorable conditions for wound healing. There are two types of surgical treatment of wounds - primary and secondary.
Primary surgical treatment of the wound - the first surgical intervention for tissue damage. Primary surgical treatment of the wound should be immediate and comprehensive. Performed on the 1st day after injury, it is called early; on the 2nd day - delayed; after 48 h from the moment of injury - late.
There are the following types of surgical treatment of wounds (case No. 4):
· Toilet wound.
· complete excision of the wound within aseptic tissues, allowing, if successfully performed, healing of the wound under the sutures by primary intention.
· Dissection of the wound with excision of non-viable tissue, which creates conditions for uncomplicated wound healing by secondary intention.
Toilet wound It is performed for any wound, but as an independent measure it is carried out for minor superficial incised wounds, especially on the face and fingers, where other methods are usually not used. By cleaning the wound we mean cleaning the edges of the wound and its circumference from dirt using a gauze ball moistened with alcohol or another antiseptic, removing adhering foreign particles, lubricating the edges of the wound with iodonate and applying an aseptic dressing. It is necessary to take into account that when cleaning the wound circumference, movements should be made from the wound outward, and not vice versa, in order to avoid introducing a secondary infection into the wound. Complete excision of the wound with the application of a primary or initially delayed suture to the wound (i.e., an operation is performed - primary surgical treatment of wounds ). Wound excision is based on the doctrine of primary infection of an accidental wound.
Stage 1- excision and dissection of the edges and bottom of the wound within healthy tissue. It should be noted that we do not always dissect the wound, but almost always excise it. We dissect in cases where it is necessary to inspect the wound. If the wound is located in the area of large muscle masses, for example on the thigh, then all non-viable tissues are excised, especially the muscles within healthy tissues along with the bottom of the wound, up to 2 cm wide. This cannot always be done completely and strictly enough. This is sometimes hampered by the tortuous course of the wound or functionally important organs and tissues located along the wound channel. After excision, the wound is washed with antiseptic solutions, thorough hemostasis is carried out and should not be washed with antibiotics - allergization.
Stage 2- the wound is sutured in layers, leaving drainage. Sometimes PSO of a wound turns into a rather complex operation and you need to be prepared for this.
A few words about the features of PSO of wounds localized on the face and hands. Wide surgical surgical treatment of wounds is not performed on the face and hands, because these areas have little tissue, and we are interested in cosmetic considerations after surgery. On the face and hands, it is enough to minimally refresh the edges of the wound, clean it and apply a primary suture. The peculiarities of the blood supply to these areas make it possible to do this. Indication for PSW of a wound: In principle, all fresh wounds should undergo PSW. But a lot depends on general condition patient, if the patient is very severe, in a state of shock, then PSO is delayed. But if the patient profuse bleeding from the wound, then, despite the severity of his condition, PSO is carried out.
Where, due to anatomical difficulties, it is not possible to completely excise the edges and bottom of the wound, a wound dissection operation should be performed. Dissection with its modern technique is usually combined with excision of non-viable and clearly contaminated tissue. After dissection of the wound, it becomes possible to inspect it and mechanically clean it, ensuring free outflow of discharge, improving blood and lymph circulation; the wound becomes accessible to aeration and therapeutic effects antibacterial agents, both introduced into the wound cavity and especially circulating in the blood. In principle, dissection of the wound should ensure its successful healing by secondary intention.
If the patient is in a state of traumatic shock, a set of anti-shock measures is carried out before surgical treatment of the wound. Only if bleeding continues is it permissible to perform immediate surgical treatment while simultaneously carrying out anti-shock therapy.
Volume surgical intervention depends on the nature of the injury. Stabbed and cut wounds with minor tissue damage, but with the formation of hematomas or bleeding, they should only be dissected in order to stop the bleeding and decompress the tissue. Wounds large sizes, the treatment of which can be done without additional tissue dissection (for example, extensive tangential wounds) are subject only to excision; through and blind wounds, especially with comminuted bone fractures, are subject to dissection and excision.
The most significant mistakes that are made when performing surgical treatment of wounds are excessive excision of unchanged skin in the wound area, insufficient dissection of the wound, which makes it impossible to carry out a reliable revision of the wound channel and complete excision of non-viable tissue, insufficient persistence in searching for the source of bleeding, tight tamponade of the wound with the aim of hemostasis, use of gauze swabs for drainage of wounds.
Timing of post-surgical treatment of wounds (case No. 5). The most optimal time for PCO is the first 6-12 hours after injury. The sooner the patient arrives and the sooner PSO of the wound is performed, the more favorable the outcome. This is early PST of wounds. Time factor. At present, they have somewhat moved away from the views of Friedrich, who limited the period of emergency treatment to 6 hours from the moment of injury. PSO, carried out after 12-14 hours, is usually forced
processing due to late admission of the patient. Thanks to the use of antibiotics, we can extend these periods, even up to several days. This is a late PST of wounds. In cases where PSC of a wound is performed late, or not all non-viable tissues are excised, then primary sutures can not be applied to such a wound, or such a wound cannot be sutured tightly, but the patient can be left under observation in the hospital for several days and if the condition further allows wounds, then sutured it tightly.
Therefore, they distinguish (sl. No. 7):
· Primary suture , when a suture is applied immediately after a wound and PST of wounds.
· Primary – delayed suture, when the suture is applied 3-5-6 days after the injury. The suture is applied to the pre-treated wound until granulation appears, if the wound is good, without clinical signs infections, in general good condition sick.
· Secondary seams which are applied not to prevent infection, but to speed up the healing of an infected wound.
Among the secondary seams there are (sl. No. 8):
A) Early secondary suture applied 8-15 days after injury. This suture is applied to a granulating wound with movable, non-fixed edges without scars. In this case, the granulations are not excised, and the edges of the wound are not mobilized.
B) Late secondary suture 20-30 days or later after injury. This suture is applied to a granulating wound with the development of scar tissue after excision of the scar edges, walls and bottom of the wound and mobilization of the wound edges.
PCS of wounds is not performed (
sl. No. 9 ):
a) for penetrating wounds (for example, bullet wounds)
b) for small ones, superficial wounds
c) for wounds on the hand, fingers, face, skull, the wound is not excised, but a toilet is performed and stitches are applied
d) in the presence of pus in the wound
e) in the event that complete excision is not feasible, when the wound walls include anatomical formations, the integrity of which must be spared (large vessels, nerve trunks, etc.)
f) if the victim is in shock.
Secondary surgical treatment of the wound carried out in cases where primary treatment has not given an effect. Indications for secondary surgical treatment of a wound are the development of wound infection (anaerobic, purulent, putrefactive), purulent-resorptive fever or sepsis caused by tissue retention, purulent leaks, peri-wound abscess or phlegmon (case number 10).
The volume of secondary surgical treatment of the wound may vary. Complete surgical debridement purulent wound involves excision within healthy tissue. Often, however, anatomical and surgical conditions (danger of damage to blood vessels, nerves, tendons, joint capsules) allow only partial surgical treatment of such a wound. When localizing inflammatory process along the wound canal, the latter is widely opened (sometimes with additional dissection of the wound), the accumulation of pus is removed, and foci of necrosis are excised. With the aim of additional rehabilitation wounds are treated with a pulsating jet of antiseptic, laser beams, low-frequency ultrasound, as well as vacuuming. Subsequently, proteolytic enzymes and carbon sorbents are used in combination with parenteral administration antibiotics. After complete cleansing of the wound, good development granulations, secondary sutures are acceptable. When an anaerobic infection develops, secondary surgical treatment is carried out most radically, and the wound is not sutured. Treatment of the wound is completed by draining it with one or more silicone drainage tubes and suturing the wound.
The drainage system allows postoperative period wash the wound cavity with antiseptics and actively drain the wound when connecting vacuum aspiration. Active aspiration-washing drainage of the wound can significantly reduce its healing time.
Thus, primary and secondary surgical treatment of wounds has its own indications for implementation, timing and volume surgical intervention(sl. no. 11).
Treatment of wounds after primary and secondary surgical treatment is carried out using antibacterial agents, immunotherapy, restorative therapy, proteolytic enzymes, antioxidants, ultrasound, etc. Effective treatment of the wounded under conditions of gnotobiological isolation (see and for anaerobic infection - with the use of hyperbaric oxygenation
Among the complications of wounds areearly: organ damage, primary bleeding, shock (traumatic or hemorrhagic) and late: seromas, hematomas, early and late secondary bleeding, wound infection (pyogenic, anaerobic, erysipelas, generalized - sepsis), wound dehiscence, scar complications ( hypertrophic scars, keloids) (case No. 12)
To the early complications include primary bleeding, injuries to vital organs, traumatic or hemorrhagic shock.
By the later complications include early and late secondary bleeding; Seromas are accumulations of wound exudate in wound cavities, which are dangerous due to the possibility of suppuration. When a seroma forms, it is necessary to ensure the evacuation and drainage of fluid from the wound.
Wound hematomas are formed in wounds closed with a suture due to incomplete stopping of bleeding during surgery or as a result of early secondary bleeding. The causes of such bleeding may be elevations blood pressure or disturbances in the patient's hemostatic system. Wound hematomas are also potential foci of infection; in addition, by squeezing tissue, they lead to ischemia. Hematomas are removed by puncture or open exploration of the wound.
Necrosis of surrounding tissues- develop when microcirculation is disrupted in the corresponding area due to surgical tissue trauma, improper suturing, etc. Wet necrosis skin must be removed due to the danger of purulent melting. Superficial dry necroses of the skin are not removed, as they play a protective role.
Wound infection- its development is promoted by necrosis, foreign bodies in the wound, accumulation of fluid or blood, disruption of local blood supply and general factors affecting the course wound process, as well as high virulence of wound microflora. There are pyogenic infections, which are caused by staphylococcus, Pseudomonas aeruginosa, coli and other aerobes. Anaerobic infection, depending on the type of pathogen, is divided into non-clostridial and clostridial anaerobic infection (gas gangrene and tetanus). Erysipelas is a type of inflammation caused by streptococcus, etc. The rabies virus can enter the body through bite wounds. When a wound infection generalizes, sepsis may develop.
Dehiscence of wound edges occurs if there are local or common factors, complicating healing, and when the sutures are removed too early. During laparotomy, wound dehiscence can be complete (eventration - exit to the outside) internal organs), incomplete (the integrity of the peritoneum is preserved) and hidden (the skin suture is preserved). Dehiscence of the wound edges is eliminated surgically.
Complications of wound scarring can be in the form of the formation of hypertrophied scars, which appear with a tendency to excessive formation of scar tissue and more often when the wound is located perpendicular to the Langer line, and keloids, which, in contrast
from hypertrophied scars have a special structure and develop beyond the boundaries of the wound. Such complications lead not only to cosmetic, but also to functional defects. Surgical correction keloids often leads to deterioration of local status.
To select adequate treatment tactics when describing the condition of the wound, a comprehensive clinical and laboratory evaluation many factors, taking into account:
· localization, size, depth of the wound, capture of underlying structures, such as fascia, muscles, tendons, bones, etc.
· condition of the edges, walls and bottom of the wound, the presence and type of necrotic tissue.
· quantity and quality of exudate (serous, hemorrhagic, purulent).
· level of microbial contamination (contamination). Critical level is the value of 105 - 106 microbial bodies per 1 gram of tissue, at which the development of a wound infection is predicted.
· time elapsed since the injury.
Primary surgical treatment, or PST, of a wound is mandatory event during treatment open wounds of various nature. The health and sometimes the life of the injured person often depends on how this procedure is carried out. A correctly drawn up algorithm of a doctor’s actions is the key to successful treatment.
Damage human body may have a varied appearance and nature of occurrence, but the basic principle of PST of a wound remains unchanged - to provide safe conditions for eliminating the consequences of a wound through minor surgical manipulations and disinfection of the affected area. The drugs and instruments may change, but the essence of the PCO does not change.
Features of open wounds
IN general case are called wounds mechanical damage body tissues with a violation of the integrity of the skin, in which gaping occurs and which are accompanied by bleeding and pain. According to the degree of damage, only soft tissue damage is distinguished; tissue damage, accompanied by damage to bones, blood vessels, joints, ligaments, and nerve fibers; penetrating injuries - with damage to internal organs. Pathologies with a small and large affected area differ in extent.
According to the mechanism of appearance, wounds can be cut, punctured, chopped, torn, crushed, bitten, gunshot; according to the form of manifestation - linear, perforated, star-shaped, patchwork. If, as a result of injury, significant skin flaps are detached, then such destruction is usually called scalped. In the presence of gunshot injuries a through wound is possible.
All open lesions are initially considered infected, since the likelihood of pathogens entering and developing in them is very high. Moreover, failure to take action within 8-10 hours can lead to sepsis. The entry of soil into the site of injury gives rise to the development of tetanus. Any open lesion is accompanied by damage blood vessels and nerve fibers, which causes heavy bleeding and pain. Many types of destruction (torn, crushed) cause necrosis of border tissues. Non-viable tissue cells appear in any affected areas if measures are not taken in the first hours after injury.
Principle of primary treatment
The first stage of treatment is to stop bleeding, eliminate pain syndrome, disinfection and preparation for suturing. The most important issue is sterilization of the affected area and removal of non-viable cells. If the injuries are not extensive and penetrating, and measures are taken in a timely manner, then disinfection can be carried out by ensuring the wound is cleaned. Otherwise, primary methods are used surgical training(PHO of the wound).
What is a wound toilet?
The principles of wound care are based on the treatment of the affected area antiseptic drug ensuring increased hygiene requirements. Small and fresh wounds do not have dead tissue around the injury, so sterilization of the area and surrounding area will be sufficient. Algorithm for toileting a purulent wound:
- Getting ready Consumables: napkins, sterile cotton balls, medical gloves, antiseptic compounds (3% hydrogen peroxide solution, 0.5% potassium permanganate solution, ethanol), necrolytic ointments (“Levomekol” or “Levosin”), 10% sodium chloride solution.
- The previously applied bandage is removed.
- The area around the lesion is treated with a solution of hydrogen peroxide.
- The state of the pathology and possible complicating factors are studied.
- The skin around the injury is cleaned using sterile balls, moving from the edge of the injury to the side, treated with an antiseptic.
- The wound is cleaned - removal of the purulent composition, wiping with an antiseptic.
- The wound is drained.
- A bandage with a necrolytic drug (ointment) is applied and fixed.
The essence of PCP wounds
Primary surgical treatment is surgical procedure, including dissection of the marginal tissue in the damaged area, removal of dead tissue by excision, removal of all foreign bodies, installation of cavity drainage (if necessary).
Thus, along with medicinal treatment, mechanical antiseptics are used, and the removal of dead cells accelerates the process of regeneration of new tissues.
The procedure begins with incision of the lesion. The skin and tissue around the destruction are dissected with a cut up to 10 mm wide in the longitudinal direction (along the vessels and nerve fibers) to a length that allows visual examination of the presence of dead tissue and stagnant zones (pockets). Then, by making an arcuate incision, the fascia and aponeurosis are dissected.
Remnants of clothing, foreign bodies, and blood clots are removed from the extended wound; By excision, crushed, contaminated and blood-soaked non-viable areas of tissue are removed. Lifeless areas of muscles (dark red), blood vessels and tendons are also eliminated. Healthy vessels and fibers are sutured. Using pliers, the sharp spike-shaped edges of the bone are bitten out (for fractures). After complete cleaning, the primary suture is applied. When treating through-and-through gunshot wounds, PSO is performed separately from both the entrance and exit sides.
PSO of facial wounds. Injuries to the jaw area are the most common of facial wounds. PCS of such wounds has a certain algorithm of actions. First, medication is given antiseptic treatment skin on the face and oral cavity.
A solution of hydrogen peroxide is applied around the damage, a solution ammonia, iodine-gasoline. Next, the wound cavity is thoroughly washed with an antiseptic. Skin covering The face is carefully shaved and disinfected again. The victim is given an analgesic.
After preliminary procedures, PSO of facial wounds is performed directly individual plan, but with the following sequence of manipulations: treatment of the bone area; treatment of soft adjacent tissues; fixation of splinters and fragments of the jaw; suturing in the sublingual area, oral vestibule and in the tongue area; wound drainage; placing the primary suture on soft fabrics wounds. The procedure is carried out under general anesthesia or under local anesthesia depending on the severity of the damage.
Algorithm for PCS of bite wounds. A fairly common occurrence, especially among children, are wounds resulting from bites from domestic animals. The PHO algorithm in this case is as follows:
- Providing first aid.
- Rinse the damaged area with a stream of water and laundry soap. copious amounts For complete removal animal saliva.
- Injection around the wound with a solution of lincomycin with novocaine; injection of drugs for rabies and tetanus.
- Treatment of damage boundaries with iodine solution.
- Carrying out PSO by excision of damaged tissue and cleaning the wound; the primary suture is applied only in the case of a bite from a vaccinated animal, if this fact has actually been established; If in doubt, a temporary bandage is applied with mandatory drainage.
Primary surgical treatment of wounds is effective way treatment open damage of any complexity.
Human skin has a colossal reserve of self-healing ability, and additional excision for the purpose of thoroughly cleaning the wound will not harm the healing process, and the removal of non-viable tissue will speed up the process of regeneration of new skin tissue.
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