Small wounds, cuts and abrasions are all common and quite common. You often encounter such troubles in everyday life. Most often, children encounter such problems, but adults are by no means immune from minor injuries.
Small wounds, cuts and abrasions are all common and quite common. You often encounter such troubles in everyday life. Most often, children encounter such problems, but adults are by no means immune from minor injuries.
On the one hand, the majority are sure that they probably know what to do - iodine, alcohol, a plaster or a bandage are the main helpers in trouble. However, everything is somewhat more complicated, because if the wound is treated incorrectly, you can get complications that will lead to infection, prolonged healing or an unsightly scar.
What are soft tissue wounds?
Soft tissue injuries include injuries to the skin, mucous membrane, deep-lying tissues (subcutaneous tissue, muscles, etc.), as well as tendons, blood vessels and nerves. As a result of a violation of the integrity of the skin, microbial contamination of the wound surface occurs, which can lead to the development of infection. According to the damaging factor, wounds are divided into mechanical, thermal (burn) and chemical; by instrument of injury - for wounds from blunt, sharp objects, tools and weapons, firearms and weapons; According to the nature of the damage, wounds are classified into bruised, lacerated, combined, bitten, stab, cut, stab-cut, chopped, sawn, combined bullet, shot, fragmentation. Based on the depth of damage, a distinction is made between superficial wounds, located in various layers of the skin, and deep wounds, occurring in deeper tissues. Wounds of internal organs and joints that communicate with the external environment through a wound channel are called open, and wounds whose wound channels pass through cavities or ending in them are called penetrating wounds. Wounds of internal organs that do not communicate with the external environment are classified as closed.
Complications of wounds. Basic principles of treatment
Wounds can be accompanied by a variety of complications, both immediately after the wounds are inflicted and in the long term. Wound complications include:
· The development of traumatic or hemorrhagic shock is the earliest and most serious complication. In the absence of immediate help, it causes an unfavorable outcome.
· Seromas are accumulations of wound exudate in wound cavities, dangerous due to the possibility of suppuration. When seroma develops, it is necessary to ensure the evacuation of fluid from the wound.
· Wound hematomas are formed due to incomplete stopping of bleeding. Hematomas are potential foci of infection; in addition, by squeezing surrounding tissues, they lead to ischemia. They must be removed by puncture or during wound revision.
· Necrosis of surrounding tissues - develops when the blood supply to the corresponding area is disrupted due to tissue trauma during surgery or improper suturing. Wet skin necrosis must be removed due to the risk of deep accumulations of pus. Superficial dry necroses of the skin are not removed, as they perform a protective function.
· Wound infection - its development is facilitated by a high level of contamination and high virulence of the microflora that has entered the wound, the presence of foreign bodies in the wound, necrosis, accumulations of fluid or blood, damage due to injury to bones, nerves, blood vessels, chronic disruption of local blood supply, as well as late surgical treatment and general factors influencing the course of the wound process. Experimental and clinical studies have established that in most cases, for the development of an infectious process in a wound, it is necessary for its contamination to exceed a critical level of 105-106 microorganisms per 1 gram of tissue. Among the general factors contributing to the development of wound infection, significant blood loss, the development of traumatic shock, previous fasting, vitamin deficiencies, overwork, the presence of diabetes mellitus and some other chronic diseases play an important role.
The development of pyogenic infection is caused by staphylococcus, Pseudomonas aeruginosa, Escherichia coli and other pyogenic bacteria, anaerobic infection - by clostridia and non-clostridial anaerobic microflora, erysipelas - by streptococci. When a wound infection generalizes, sepsis develops. Most often, the development of pyogenic wound infection occurs on days 3-5 after injury, less often at a later date - on days 13-15. Anaerobic infection can develop very quickly; in fulminant forms, it is diagnosed a few hours after injury.
If it gets into the wound with soil, dust, foreign bodies, Cl. Tetani may develop tetanus. In the absence of specific prevention, the probability of contracting tetanus in the presence of contaminated wounds reaches 0.8%. The rabies virus can enter the body through bite wounds.
· Dehiscence of wound edges - occurs in the presence of local or general factors that impede healing, as well as when sutures are removed too early. During laparotomy, the divergence of the edges of the wound can be complete - with eventration, that is, with internal organs coming out, incomplete - with preservation of the integrity of the peritoneum, and hidden, when the integrity of the skin is preserved. Dehiscence of the wound edges is eliminated surgically.
· Complications of scars are the formation of hypertrophied scars and keloids. Hypertrophied scars develop when there is a tendency to excessive formation of scar tissue and most often when the wound is located perpendicular to the Langer line. Keloids, unlike hypertrophied scars, have a special structure and spread beyond the boundaries of the wound. Complications of scars lead not only to cosmetic, but also to functional defects, such as impaired walking or upper limb function due to limited range of motion in the joints. Surgical correction is indicated for hypertrophied scars with impaired function, but for keloids it often leads to a deterioration in the treatment outcome.
· Long-term chronic wounds can be complicated by the development of malignancy. The diagnosis is confirmed by a biopsy of wound tissue. Surgical treatment requires radical excision within healthy tissue.
Basic principles of wound care
Treatment for injuries usually takes place in two stages - the first aid stage and the qualified assistance stage.
¨ First aid stage
When providing first aid at the site of injury, two main tasks are solved: stopping bleeding and preventing further microbial contamination. First aid includes the use of available methods to temporarily stop bleeding, pain relief, application of a protective bandage and transport immobilization. At this stage, you should not wash the wound or remove foreign bodies from it.
¨ Qualified assistance stage
At the stage of hospital care, the following tasks are solved:
· prevention and treatment of wound complications;
· acceleration of the healing process;
· restoration of functions of damaged organs and tissues.
Basic principles of wound treatment:
· strict adherence to asepsis at all stages of treatment;
· mandatory surgical treatment;
· active drainage;
· the earliest possible closure of wounds with primary or secondary sutures or using autodermoplasty;
· targeted antibacterial and immunotherapy, correction of systemic disorders.
To select adequate wound treatment tactics, a thorough assessment of its condition is necessary, and the following is assessed:
· Localization, size, depth of the wound, damage to underlying structures such as fascia, muscles, tendons, bones.
· The condition of the edges, walls and bottom of the wound, as well as surrounding tissues, the presence and characteristics of necrotic tissue.
· The quantity and quality of exudate - serous, hemorrhagic, purulent.
· Level of microbial contamination. The critical level is the value of 105 - 106 microbial bodies per 1 g of tissue, at which the development of a wound infection is predicted.
· Time elapsed since injury.
¨ Treatment of contaminated wounds
The risk of developing wound complications in the presence of contaminated wounds is much higher than in aseptic wounds. Treatment of contaminated wounds consists of the following steps:
· In case of possible contact of the wound with the ground (all injuries with a violation of the integrity of the body, frostbite, burns, gangrene and tissue necrosis, out-of-hospital births and abortions, animal bites), measures are necessary to prevent a specific infection - tetanus, and in case of animal bites - rabies.
In order to prevent tetanus, vaccinated patients are administered 0.5 ml of adsorbed tetanus toxoid, unvaccinated patients - 1 ml of toxoid and 3000 IU of tetanus toxoid serum. Due to the danger of developing anaphylactic reactions to protein, the administration of anti-tetanus serum is carried out according to Bezredko: first, 0.1 ml of diluted serum is injected intradermally, if the size of the papule is less than 10 mm, after 20 minutes 0.1 ml of undiluted serum is injected subcutaneously, and only if there is no reaction to subcutaneous administration After 30 minutes, the entire dose is administered subcutaneously.
In case of bites from animals (dogs, foxes, wolves, etc.) suspected of rabies, or their saliva getting on damaged tissue, primary surgical treatment of the wound cannot be performed. The wound is only washed and treated with an antiseptic. There are no stitches. A course of subcutaneous administration of rabies vaccine is required, which is performed in specialized rabies centers, and tetanus prophylaxis. In the presence of superficial injuries (abrasions, scratches) of any location except the head, neck, hands, toes and genitals caused by domestic animals, culture purified concentrated rabies vaccine (COCAV) is administered 1 ml immediately, as well as on 3, 7, 14, 30 and 90 days. But if, when observing the animal, it remains healthy for 10 days, then treatment is stopped after 3 injections.
If animal saliva gets on the mucous membranes, if bites are localized in the head, neck, hands, toes and genitals, as well as with deep and multiple bites and any bites of wild animals, in addition to the administration of COCAB, immediate administration of rabies immunoglobulin (RAI) is necessary. Heterologous AIH is prescribed at a dose of 40 IU per kg of body weight, homologous - at a dose of 20 IU per kg of body weight. Most of the dose should be infiltrated into the tissue surrounding the wound, the rest is administered intramuscularly. If observation of the animal is possible, and it remains healthy for 10 days, then the administration of COCAV is stopped after the 3rd injection.
· In all cases of contaminated wounds, except for minor superficial injuries and cases where there are cosmetic and functional contraindications, primary surgical treatment (PST) with wound dissection, revision of the wound canal, excision of the edges, walls and bottom of the wound is mandatory. The purpose of PSO is the complete removal of non-viable and contaminated tissue. The later PST is performed, the lower the likelihood of preventing infectious wound complications.
PSO is not performed when wounds are localized on the face, as it leads to an increase in cosmetic defect, and good blood supply to this area ensures a low risk of suppuration and active wound healing. With extensive wounds of the scalp, performing PSO in full can lead to the impossibility of matching the edges and closing the wound. Non-penetrating puncture wounds without damage to large vessels and bite wounds with suspected penetration of the rabies virus are also not subject to PSO. PSO can be completed with the application of primary sutures - with suturing tightly or, in the presence of risk factors for wound suppuration, - with drainage left in place.
Preferably, flow-wash drainage of sutured wounds followed by dialysis with effective antiseptics. Flow-flushing drainage is carried out by installing counter perforated drains, one of which is used to administer the drug, and the other is used for outflow. The administration of drugs can be jet and drip, fractional or continuous. In this case, outflow can be carried out in a passive or active way - using vacuum.
This method protects wounds from secondary contamination, promotes more complete removal of discharge, creates conditions for a controlled abacterial environment and favorable conditions for wound healing. When draining, several general principles must be followed. Drainage is installed in sloping areas of the wound cavity, where fluid accumulation is maximum. Removing the drainage tube through the counter-aperture is preferable than through the wound, since the drainage, being a foreign body, interferes with the normal healing of the wound and contributes to its suppuration.
If there is a high risk of developing wound suppuration, for example, in the presence of sudden changes in the surrounding tissues, the application of primary delayed sutures, including provisional ones, is indicated. Like the primary ones, these sutures are placed on the wound before the development of granulation tissue, usually 1-5 days after PSO when the inflammatory process subsides. The healing of such wounds proceeds according to the type of primary intention. Sutures are not applied only after treatment of gunshot wounds and if it is impossible to compare the edges of the wound without tension; in the latter cases, the earliest possible closure of the wound defect using reconstructive surgery is indicated.
· Antibiotic prophylaxis is carried out according to the same scheme as for “dirty” surgical interventions. A 5-7 day course of antibiotics is required.
· Antiseptic prophylaxis involves the use of effective antiseptics at all stages of the operation and when caring for the wound. When treating wounds, chlorhexidine, sodium hypochlorite, dioxidine, lavasept, hydrogen peroxide, potassium permanganate and other antiseptics can be used. Drugs such as furatsilin, rivanol, chloramine are currently not recommended for use in surgical departments, since hospital microflora are resistant to them almost everywhere.
· Wound management after PSO with suturing is similar to the management of surgical wounds. Regular changes of aseptic dressings and drainage care are performed. Treatment of open wounds after PSO is carried out, like the treatment of purulent wounds, in accordance with the phases of the wound process.
¨ Treatment of purulent wounds
Treatment of purulent wounds is complex - surgical and conservative.
· In all cases of infected wounds, when there are no special functional contraindications, secondary surgical debridement (SDT) is performed. It consists of opening a purulent focus and leaks, evacuation of pus, excision of non-viable tissue and mandatory provision of adequate drainage of the wound. If the wound is not sutured after VChO, secondary sutures may be applied in the future. In some cases, with radical excision of an abscess during VCO, primary sutures can be applied with mandatory drainage of the wound. Preferably flow-through drainage. If there are contraindications to carrying out VChO, they are limited to measures to ensure adequate evacuation of exudate.
· Further local treatment of purulent wounds depends on the phase of the wound process.
In the inflammation phase, the main goals of treatment are fighting infection, adequate drainage, accelerating the process of wound cleansing, and reducing systemic manifestations of the inflammatory reaction. The basis is treatment with bandages. For all wounds that heal by secondary intention, wet debridement is considered the standard treatment method. Dry debridement with the application of dry sterile wipes to the wound is used only for temporary covering of wounds and treatment of wounds that heal by primary intention.
Wet treatment uses bandages that create a moist environment in the wound. Osmotically active substances, antiseptics, and water-soluble ointments are used. Fat-soluble ointments are contraindicated as they interfere with the outflow of secretions. It is possible to use modern atraumatic dressings with high absorption capacity that maintain a certain level of moisture and help remove exudate from the wound and firmly retain it in the dressing. Modern combination preparations for local treatment of wounds contain immobilized enzymes - gentacycol, lysosorb, dalcex-trypsin.
Dressings should be changed with adequate pain relief. The frequency of changing dressings depends on the condition of the wound. Typically, 1-2 changes of dressings per day are required, hydroactive dressings such as Hydrosorb can remain on the wound for several days, the need to immediately change the dressing arises in the following cases: the patient complains of pain, a fever has developed, the dressing is wet or dirty, or its fixation is impaired. At each dressing, the wound is cleaned of pus and sequestration, necrosis is excised and washed with antiseptics. Chlorhexidine, sodium hypochlorite, dioxidine, lavacept, hydrogen peroxide, and ozonated solutions can be used to wash the wound. To accelerate necrolysis, proteolytic enzymes, ultrasonic cavitation, vacuum wound treatment, and pulsating jet treatment are used. Physiotherapeutic procedures include ultraviolet irradiation of the wound, electro- and phonophoresis with antibacterial and analgesic substances.
In the regeneration phase, the main goals of treatment are to continue the fight against infection, protect granulation tissue and stimulate repair processes. There is no longer any need for drainage. Dressings applied during the regeneration phase should protect the wound from trauma and infection, not stick to the wound and regulate the humidity of the wound environment, preventing both drying and excess moisture. Dressings with fat-soluble antibacterial ointments, stimulating substances, and modern atraumatic dressings are used.
After complete cleansing of the wound, secondary sutures or adhesive tape are indicated; for large defects, autodermoplasty is indicated. Unlike primary sutures, secondary sutures are applied to granulating wounds after the elimination of the inflammatory process. The goal is to reduce the volume of the wound defect and the entry point for infection. After 21 days, secondary sutures are applied only after excision of the formed scar tissue. In cases where it is impossible to compare the edges to close the defect, autodermoplasty is performed as early as possible - immediately after the inflammatory process has subsided.
In the phase of scar reorganization, the main goal of treatment is to accelerate epithelization and protect the wound from trauma. Since drying causes a crust to form, which slows down epithelization, and epithelial cells die with excess moisture, dressings should still keep the wound in a moderately moist state and protect against injury. Bandages with indifferent and stimulating ointments are applied. Sometimes physiotherapy is used - ultraviolet irradiation, laser, pulsating magnetic field.
· General treatment of purulent wounds includes antibacterial therapy, detoxification, immunotherapy, and symptomatic treatment.
Antibacterial therapy is used in phases 1-2 of the wound process. The drug must be prescribed taking into account the sensitivity of the wound microflora. Systemic administration of antibiotics is indicated; topical administration is not currently recommended. The initial empirical choice of antibacterial therapy, pending sensitivity results, should be directed against typical pathogens, which are staphylococci, streptococci and gram-negative aerobic bacteria.
Amoxiclav, levofloxacin are used, as a reserve - cefuroxime, ciprofloxacin, ofloxacin, and for bites - doxycycline. Treatment of staphylococcal wound infections with pathogen resistance requires the use of vancomycin or linezolid. For erysipelas, penicillins, azithromycin, and lincosomide are indicated. If the infection is caused by Pseudomonas aeruginosa, the drugs of choice are carbenicillin, tazocin, timentin, as well as 3rd generation cephalosporins and fluoroquinolones. In addition to antibiotics, bacteriophages are used in the treatment of purulent wounds.
Detoxification is used in the presence of systemic manifestations of the inflammatory process. Infusions of saline solutions, detoxifying solutions, forced diuresis, and in severe cases, extracorporeal detoxification are used.
Immunocorrective therapy can be specific (vaccines, serums, toxoids) and nonspecific. Tetanus toxoid, antitetanus and antigangrenous serum, antitetanus and antistaphylococcal gamma globulin are often used. Among the means of nonspecific immunotherapy in patients with purulent wounds, only immunomodulators are used, and only in the presence of immune disorders and always in combination with an antimicrobial drug, since they aggravate the course of the infection. Synthetic immunomodulators, such as diocephon and polyoxidonium, are the most promising. Polyoxidonium has the properties not only to restore the impaired immune response, but also to absorb toxins, and is also an antioxidant and membrane stabilizer. Usually prescribed 6 mg 2 times a week, a full course of 5-10 injections.
Symptomatic therapy includes pain relief, correction of organ and system disorders, and correction of homeostasis disorders. For pain relief, non-narcotic analgesics are usually used, however, in the early postoperative period, as well as in case of extensive injuries, narcotic drugs can be used. When the temperature rises above 39° C or fever against the background of severe diseases of the cardiovascular and respiratory systems, the prescription of antipyretic drugs is required.
¨ Prevention of infectious complications of surgical wounds
Surgical wounds are applied under conditions that minimize the risk of wound complications. In addition, before inflicting a wound, it is possible to prevent wound complications. Prevention of complications of surgical wounds includes:
· Preparation for surgery
Before a planned operation, a thorough examination of the patient is carried out, during which existing risk factors for wound complications are identified. When assessing the degree of risk, the patient’s age, nutritional status, immune status, concomitant diseases, homeostasis disorders, previous drug treatment, the condition of the tissue in the area of the proposed incision, and the type and duration of the upcoming surgical intervention are taken into account. The existing disorders are corrected and the patient is directly prepared for surgery, taking into account the requirements of asepsis.
During operations on the colon, as well as during extensive surgical interventions in extremely critically ill patients, selective intestinal decontamination is performed to prevent infectious complications. Selective intestinal decontamination reduces the risk of enterogenous infection resulting from the translocation of intestinal microorganisms. Typically a combination of an aminoglycoside or fluoroquinolone with polymyxin and amphotericin B or fluconazole is used.
With each day of hospital stay, the patient’s contamination with pathogens of hospital infections increases, so the stage of inpatient preoperative preparation should not be delayed unnecessarily.
· Careful adherence to surgical techniques
When performing surgery, careful handling of tissues, careful hemostasis, preservation of blood supply to tissues in the wound area, obliteration of the resulting “dead” space, comparison of the edges of the wound and their suturing without tension are necessary. The sutures should not be ischemic, but should ensure complete closure of the wound edges. Whenever possible, the suture material left in the wound should be absorbable and monofilament. In addition, the duration of the operation plays an important role. As it increases, the degree of wound contamination and tissue susceptibility to wound infection pathogens increases due to tissue drying, impaired blood supply, and reactive edema.
· Antibiotic prophylaxis
Antibiotic prophylaxis of infectious wound complications depends on the type of surgical procedure. In clean operations, it is indicated only in the presence of factors that adversely affect the course of the wound process, such as immunodeficiency states, diabetes mellitus, and taking immunosuppressants. For most clean and conditionally clean operations, as well as for contaminated interventions in the upper gastrointestinal tract, 1-2 generation cephalosporins, such as cefazolin or cefuroxime, can be used for antibiotic prophylaxis. For contaminated operations on the colon, biliary system and internal genital organs, the use of protected aminopenicillins or 1-2 generation cephalosporins in combination with metronidazole is indicated.
During perioperative prophylaxis, average therapeutic doses of antibiotics are used. The first dose of the drug is administered intravenously 30-60 minutes before the skin incision, usually during induction of anesthesia. If the operation lasts more than 2-3 hours, repeated administration of the antibiotic is required to maintain its therapeutic concentration in the tissues throughout the entire surgical procedure. In most cases, the duration of antibiotic administration does not exceed 24 hours, however, the presence of additional risk factors necessitates the need to extend prophylaxis to 3 days. For “dirty” interventions, a full course of antibiotic therapy is indicated, which should begin in the preoperative period.
· Antiseptic prophylaxis
Antiseptic prophylaxis involves the use of effective antiseptics at all stages of the operation, including for treating the skin, washing cavities, and subcutaneous tissue. General requirements for the antiseptics used: wide spectrum of action, high bactericidal activity, toxicological safety. To treat the skin, iodophors, chlorhexidine, and surfactants are usually used; for washing cavities, chlorhexidine, sodium hypochlorite, and dioxidine are used.
· Drainage of surgical wounds
Drainage of surgical wounds is carried out according to certain indications. It is necessary when it is impossible to obliterate the “dead space” formed after surgery, when there is a large area of the wound surface of the subcutaneous fat, when using artificial materials for plastic surgery of the aponeurosis, and in some other cases that create the preconditions for the formation of seromas. Drainage is also mandatory for radical excision of ulcers with suturing of the postoperative wound. Aspiration or flow-wash drainage is preferable, while proper care of the drainage system in the postoperative period is mandatory.
· Proper wound management in the postoperative period
Local cold is prescribed immediately after the operation, adequate pain relief, regular changes of aseptic dressings and drainage care are performed, and, if indicated, dialysis and wound evacuation, physiotherapy and other measures.
¨ Control of wound treatment
The effectiveness of wound treatment is assessed by the dynamics of general and local signs of inflammation. They focus on the subsidence of fever, leukocytosis, pain in the wound area, and normalization of the patient’s general well-being. During dressings, the condition of the sutures, the presence and extent of hyperemia and edema in the wound circumference, necrosis of the wound edges, the type of wound discharge and granulations are visually assessed. To monitor the course of the wound process in the treatment of drained wounds, instrumental research methods can be used.
An endoscopic method of examining the wound is used with simultaneous biopsy of subcutaneous fat for bacteriological examination. In this case, during dressing, an endoscope optical tube with end optics with a diameter of 3-6 mm is inserted through the drainage of the postoperative wound, the presence of wound exudate, areas of necrosis, and fibrin is assessed, then a biopsy is taken. The degree of contamination of wound tissue is determined using express methods, for example, phase-contrast microscopy. After taking a biopsy, the wound channel is filled with physiological solution to assess the correct location of the drains and the direction of the fluid flow during its jet injection.
Favorable endoscopic signs of the course of the wound process and indications for stopping drainage are: the presence of bright pink granulations, the absence of pus, necrosis, a significant amount of fibrin, tissue contamination below critical. Sluggish granulations, the presence of a large amount of exudate and fibrin in the wound, as well as high bacterial contamination require continued dialysis of the wound with antiseptic solutions.
After removal of the drainage systems, an ultrasound scan is indicated to assess the condition of the wound channel and surrounding tissues. Favorable ultrasound signs of the course of the wound process are:
· narrowing of the wound channel the next day after removal of the drainage tubes, its visualization in the form of a heterogeneous echo-negative strip by 3-5 days, absence of dilation and disappearance of the channel by 6-7 days;
· uniform echogenicity of surrounding tissues, absence of additional formations in them.
Unfavorable ultrasound signs of the course of the wound process are dilatation of the drainage channel and increased echogenicity of the surrounding tissues with the appearance of additional formations in them. These symptoms indicate the development of purulent-inflammatory wound complications even before the appearance of their clinical signs.
When treating a purulent wound, daily monitoring of the course of the wound process is necessary. With continued exudation and sluggish granulation, treatment adjustment is required. In addition to visual assessment of the condition of the wound and assessment of the severity of general clinical and laboratory symptoms, various methods are used to monitor the dynamics of the microbial landscape, the level of contamination and regenerative processes in tissues: bacteriological, cytological, modern high-precision gas-liquid chromatography, tests using enzyme systems and others.
Causes
Incised wounds occur as a result of direct impact of a sharp weapon on the surface of the skin. Slash wounds are created when a sharp weapon is brought down onto the skin at an angle. Puncture wounds are the result of deep penetration by a sharp, thin instrument. Possible injury to cavities or joints. Contusion wounds occur when some part of the body comes into contact with a hard obstacle and there is solid support in the form of the skull or other bone. Crushed, crushed wounds are formed due to the impact of a blunt instrument with a wide surface when opposed to a solid support. Bite wounds. As a result of an animal or human bite, highly virulent wound infection pathogens can enter the wound.
Symptoms
You can suspect a closed injury if you know the mechanism of injury (for example, a blow with a blunt object) and if one or more signs are present: bruising, swelling, pain. Some signs suggest the nature of the injury. For example, swelling and deformity may indicate a closed fracture. A bruise on the head, bloody discharge from the nose, ears and mouth - possible injury to the cervical spine or brain. Bruises on the chest, deformation, violation of symmetry - possible chest injury with damage to the ribs and sternum. Troubled breathing may indicate a lung injury. Large bruises on the abdomen – possible injury to an internal organ. Signs of a wound vary depending on the type and depth of tissue damage. As a rule, any damage is accompanied by pain, possible violation of the integrity of the skin, as well as bleeding.
Diagnostics
For small superficial wounds that are not accompanied by general symptoms, the diagnosis is made based on the clinical picture. A detailed examination is carried out during the initial treatment of the wound. For extensive and deep wounds with a violation of the general condition, additional studies are necessary, the list of which is determined taking into account the location of the damage. For injuries in the chest area, a chest x-ray is prescribed, for injuries in the abdominal area, an abdominal x-ray, ultrasound or laparoscopy, etc. If a violation of the integrity of blood vessels and nerves is suspected, consultation with a neurosurgeon and vascular surgeon is required.
Types of abrasions and wounds
We encounter cuts and all kinds of abrasions in everyday life. An abrasion is damage caused by mechanical friction against a rough and rough surface, often hard. This may be the result of a fall on asphalt or gravel.
The abrasion may be superficial, in which case only the epidermis is affected. The area turns red and swells a little. If the injury is deeper, then not only the epidermis is damaged, but also the capillaries, which leads to pinpoint bleeding, droplets of blood are released, but most importantly, the person experiences severe pain.
A cut is a shallow cut wound. With such an injury, either only the skin is damaged, or the layer of fatty tissue is affected. In such cases, bleeding occurs, the intensity of which will be determined by the depth of the cut and the number of damaged vessels.
Wounds can be superficial or deep, and large vessels can even be damaged. In this case, severe bleeding occurs. Wounds may be accompanied by bruises and bruises. In addition, dirt, various objects, earth, etc. often get into the wound.
Treatment
First medical aid consists of primary surgical treatment of the wound, during which foreign bodies are removed from the wound, bleeding is stopped, the wound is washed with antiseptics, and non-viable tissue is excised. The issue of preventing tetanus and rabies (if the wound is a bite) is also being addressed. Wounds with severe inflammation are not sutured; they are drained. An infected wound heals by secondary intention. Dressings and drainage changes are performed daily. General treatment consists of anti-inflammatory therapy, administration of hemostatic agents, and painkillers. In case of heavy blood loss, the issue of replacing the volume of circulating blood (CBV) is resolved, blood substitutes and blood components are introduced. Subsequently, in case of severe scar contractures and deformities, restorative surgery may be repeated. Most often, superficial wounds do not bleed much. Therefore, help consists of bandaging the wound. Before this procedure, the edges are lubricated with an antiseptic, making sure that it does not get into the wound. The wound is covered with a sterile napkin and bandaged. If the edges of the wound are significantly separated, before applying bandages they must be brought together (but not until they are closed) and fixed in this position with 2-3 strips of adhesive tape. The wound should not be washed with water (risk of infection), or with alcohol or iodine tincture. A disinfectant solution entering a wound causes the death of damaged cells and also causes significant pain. Do not apply any ointment to the wound, or place cotton wool directly into the wound. We should not forget about vitamin therapy. Vitamin deficiency sharply slows down reparative (restorative) processes. To speed up wound healing, proper nutrition of patients is important, especially those who have suffered traumatic shock, severe infection or major surgery. They need a complete diet with increased amounts of protein and vitamins. Physical therapy is indicated primarily for purulent wounds of the upper extremities. Physiotherapeutic procedures play an important role: ultraviolet irradiation, UHF, etc.
Reasons for visiting a doctor
You should consult a doctor if the wound or abrasion is accompanied by problems. In the following cases, you should definitely visit a specialist:
- The wound was caused by a rusty object - it could be a simple nail, but in such cases a tetanus vaccine may be required.
- If the edges of the wound diverge greatly and require suturing. If stitches are not applied, the result will be a strong and deep scar, and healing will be slow.
- If the wound is accompanied by severe bleeding that cannot be stopped within 20-30 minutes. In such cases, either blood clotting may be impaired or a large and important vessel may be damaged.
- If the area around the wound is very swollen, swelling and suppuration appear, all this is accompanied by twitching pain and fever. In such cases, surgical debridement and, probably, drug therapy are necessary, since the symptoms indicate infection of the wound.
IMPORTANT : even the smallest and most insignificant wound is a violation of the skin, which pathogenic microbes and bacteria can use as an entrance gate. Tetanus bacteria are especially dangerous. Be sure to treat everything, even minor abrasions and cuts.
