Purulent wounds all over the body. Suppuration

Like any other, purulent inflammation is the body’s response to the influence of any irritant, aimed at limiting the pathological area, destroying provoking agents and restoring damage. The inflammatory response consists of three successive phases: damage, swelling, recovery. It is the nature of the edema that determines the type of inflammation.

Purulent inflammations develop when pathogenic pyogenic bacteria predominate in the edematous fluid (exudate). These can be Pseudomonas aeruginosa and Escherichia coli, staphylo-, gono-, streptococci, Klebsiella, Proteus. The degree of bacterial contamination of the injury site determines the likelihood and nature of the inflammatory reaction.

Pus is a liquid medium containing dead blood cells (leukocytes, phagocytes, macrophages), microbes, enzymes (proteases), destroyed and dead tissue, fats, and protein fractions. It is proteases that are responsible for tissue dissolution (lysis) at the site of damage.

The following types of purulent inflammation are distinguished:

empyema - accumulation of pus in the cavity represented by the walls of the organ;
abscess - a cavity resulting from the melting of tissue, filled with purulent exudate;
phlegmon - diffuse purulent throughout the vessels, nerves, and fascia.

One of the most common benign tumors in subcutaneous tissues is atheroma. It is formed in places where the sebaceous glands are most widespread: the head, tailbone area, face, neck. Atheroma has the appearance of a round formation; it is a cavity enclosed in a capsule containing fat, cholesterol, and skin cells.

It occurs as a result of the fact that the excretory duct of the sebaceous gland is clogged. Atheroma can be single, but in most cases there is multiple distribution of these formations of various sizes. This tumor is painless and, apart from cosmetic discomfort, does not cause inconvenience.

There are primary (congenital) and secondary atheromas that occur with seborrhea. On palpation they are dense, moderately painful, and have a bluish tint. Secondary tumors are localized on the face, chest, back, and neck. After opening them, ulcers with undermined edges are formed.

In outpatient surgery, atheroma inflammation is a common problem. Predisposing factors to this are the following conditions:

insufficient hygiene;
self-squeezing pimples, especially if antiseptic rules are not followed;
microtraumas (scratches and cuts);
pustular skin diseases;
decreased local immunity;
hormonal disorders;
abuse of cosmetics.

Suppurating atheroma is characterized by pain, local redness and swelling. With large sizes, fluctuation may be observed - a sensation of fluid flowing in the elastic cavity. Sometimes the formation breaks out on its own and sebaceous pus is released.

Inflammation of atheroma can only be treated surgically. A skin incision is made, the contents are peeled out with the mandatory removal of the capsule. When it is not completely removed, relapse is possible after surgery. If atheroma re-forms, inflammation may develop in the same area.

Suppuration of wounds

Wounds occur for numerous reasons: domestic, industrial, criminal, combat, after surgery. But wound inflammation is not always purulent. It depends on the nature and location of the damage, the condition of the tissues, age, and contamination with microbes.

Factors predisposing to inflammation of the wound surface are the following:

injury from a contaminated object;
failure to comply with hygiene rules;
use of steroid hormones and/or cytostatics;
excess body weight;
malnutrition;
vitamin deficiency;
elderly age;
decreased local and general immunity;
chronic skin diseases;
severe somatic illnesses;
hot, humid weather;
insufficient wound drainage after surgery.

Typically, wound suppuration is characterized by the accumulation of purulent inflammatory exudate in the tissue defect. At the same time, hyperemia (redness) and “warm” swelling appears around the edges, caused by vasodilation. In the depths of the wound, “cold” swelling predominates, associated with impaired lymphatic outflow due to compression of blood vessels.

Against the background of these signs, bursting, pressing pain appears, and the temperature in the affected area is locally increased. A necrotic mass is determined under the layer of pus. Absorbed into the blood, decay products and toxins cause symptoms of intoxication: fever, weakness, headaches, loss of appetite. Therefore, if wound inflammation occurs, treatment should be immediate.

Suppuration of postoperative sutures

The process of inflammation of the postoperative suture usually occurs 3-6 days after surgical procedures. This is due to the entry of pyogenic microorganisms into the site of tissue damage. Bacteria can be introduced into a wound primarily (by a wounded object, poorly treated instruments, by the hands of medical personnel and/or the patient himself) and indirectly from a source of chronic infection: caries, tonsillitis, sinusitis.

Predisposing factors to the development of a pathological process in the suture area:

insufficient disinfection of medical equipment;
failure to comply with the rules of asepsis and antiseptics;
reduced immunity;
poor drainage of wound discharge;
damage to subcutaneous tissue (hematomas, necrosis);
poor quality suture material;
lack of hygiene by the patient;
areas of ischemia (lack of blood supply) due to clamping of blood vessels with a ligature.

If inflammation of the suture has developed, symptoms such as redness and swelling of the surrounding skin and pain will be observed. First, serous fluid mixed with blood may separate from the suture, and then suppuration occurs.

With a pronounced inflammation process, fever with chills, lethargy, and refusal to eat appear.

A festering surgical suture should be treated only under the supervision of a physician. Incorrect independent actions can lead to the spread of infection, deepening of inflammation and the development of serious complications, including... This creates a rough, convoluted scar.

Purulent lesions of the skin and subcutaneous tissue

Pathological processes in the skin and underlying layers are very common in surgical practice. The skin and its appendages are the body’s first protective barrier from various adverse effects.

Negative factors that provoke the development of skin inflammation are:

mechanical damage (scratches, abrasions and cuts, scratching);
exposure to high and low temperatures (burn, frostbite);
chemical agents (household alkalis, acids, abuse of antiseptics and detergents);
excessive sweating and sebum secretion can cause purulent inflammation of the skin;
poor hygiene (especially in obese people);
diseases of internal organs (pathologies of the endocrine, digestive systems;
ingrown nail.

Microbes introduced from outside and/or representatives of opportunistic flora can cause purulent inflammation of the skin and subcutaneous tissue. Skin suppurations vary in location and clinical course.

Furuncle

Suppuration of the sebaceous gland - boil. It can be localized in areas of the skin where there is hair. Occurs at any age. Most common in patients with diabetes and/or obesity.

Clinical manifestations are expressed in typical inflammation: hyperemia, pain, increased local temperature, swelling. Sometimes this condition is accompanied by a reaction of nearby lymph nodes.

Complications of furunculosis can include lymphadenitis, abscess, thrombophlebitis (inflammation of the veins), phlegmon, reactive purulent arthritis, sepsis, and meningitis.

Carbuncle

Carbuncle is an acute infectious inflammation of several hair follicles with sebaceous glands simultaneously. It occurs more often in mature and elderly people. Endocrine disorders play a major role in the development of this inflammation. Typical localization is the back of the neck, back, abdomen, buttocks.

At the site of infection, dense diffuse swelling occurs, the skin becomes purple and painful. Necrotic melting of tissue occurs. The carbuncle opens in several places and creamy pus is released. The lesion with such inflammation of the skin has the appearance of a honeycomb.

Hidradenitis

Inflammation of the sweat glands occurs mainly due to uncleanliness, diaper rash, and scratching. Shaving the armpits ranks first among the provoking factors. Microtraumas of the skin occur, and the use of deodorant contributes to blockage of the excretory ducts of the glands.

A dense, painful lump forms in the armpit area, and the skin becomes purple-bluish. As inflammation develops, the pain intensifies and interferes with movements. A fluctuation occurs, the skin in the center becomes thinner, and thick pus breaks out.

When inflammation spreads to other areas, due to the abundance of lymphatic tissue, a conglomerate of nodes with protruding skin papillae is formed - a “bitch udder”. If treatment is not carried out, the process can spread - an abscess or phlegmon forms. A serious complication of hidradenitis is sepsis.

Abscess

A purulent-necrotic cavity limited by a capsule is an abscess. More often it occurs as a complication of inflammation, pustular diseases on the skin.

The cause of the development of a purulent cavity can be inflammation of a puncture wound or injection site when the outflow of pus is impaired.

Clinically, an abscess is manifested by swelling and hyperemia of the skin in the affected area. A dense, elastic, painful formation is palpated deep in the tissues. The skin over the abscess is hot to the touch. Symptoms of intoxication appear.

When an abscess is opened and is not completely emptied or there is a foreign body in the cavity, the walls of the capsule do not close completely and a fistula is formed. A breakthrough of pus can occur on the skin, into surrounding tissues, and into organ cavities.

Phlegmon

A purulent-necrotic process of inflammation, located in the cellular space, without clear boundaries. The causes of phlegmon are the same as for an abscess.

In connection with the development of aesthetic medicine, the formation of phlegmon can be provoked by corrective procedures: liposuction, the introduction of various gels. The location can be any, but the areas of the abdomen, back, buttocks, and neck are more likely to become inflamed. Damage to leg tissue is not uncommon.

Gradually melting the tissue, phlegmon spreads through the fiber and fascial spaces, destroying blood vessels and provoking necrosis. Often phlegmon is complicated by an abscess, hidradenitis, or boil.

Paronychia and felon

Panaritium is an inflammation of soft tissues, bones and joints of the fingers, and less commonly the foot. The pain of felon can be unbearable and deprive you of sleep. At the site of inflammation there is hyperemia and swelling. As the process progresses, the function of the finger is impaired.

Depending on the location of the lesion, felon can be of different types:

cutaneous - the formation of suppuration between the epidermis and the next layers of skin with the formation of a “bubble”;
subungual - pus flows under the nail plate;
subcutaneous – purulent-necrotic process of soft tissues of the finger;
articular – damage to the phalangeal joint;
tendon - suppuration of the tendon (tenosynovitis);
bone - the transition of a purulent process to the bone, proceeding as osteomyelitis.

Paronychia is damage to the ridge around the nail. maybe after a manicure, cuticle trimming. In this condition, throbbing pain, redness, and discharge of pus are noted.

Treatment

Surgery deals with purulent inflammation of soft and other tissues of the body. If symptoms indicating a purulent lesion appear, you should definitely consult a doctor. Self-treatment is fraught with the spread of the process and aggravation of the situation. Main areas of treatment:

The following methods are used for surgical treatment of wounds:

physical (laser radiation, plasma flows, vacuum treatment of the inflammation zone);
chemical (various enzyme preparations: Trypsin, Chymotrypsin, Lyzosorb);
biological (removal of necrotic tissue by green fly larvae).

For conservative therapy, the following drugs are used:

antiseptics (Povidone-iodine, Miramistin, Ethacridine, Chlorhexidine);
water-soluble ointments (Dioxidin, Methyluracil);
creams (Flamazin, Argosulfan);
draining sorbents (Collagenase);
aerosols (Lifuzol, Nitazol).

During the regeneration (healing) period after surgery, the following means are used:

dressings with antibacterial ointments (Levomekol, Tetracycline, Pimafucin), stimulating substances (Vinilin, Actovegin, Solcoseryl);
special wound coverings against inflammation and for healing (Voscopran);
preparations based on natural polymers (Algipor, Kombutek).

Purulent inflammation of various parts of the body is common and has many different forms. The course of the process can be smooth or bring serious complications leading to death. Therefore, treatment must be approached comprehensively and the full range of prescribed therapeutic measures and preventive measures to prevent the secondary occurrence of the disease must be carried out.

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 is dying tissue, hemorrhage and lymphatic effusions. In addition, wounds, even clean operating wounds, receive one or another number of microbes.

When wounds heal, dead cells, blood, and lymph are reabsorbed and, due to the inflammatory reaction, the process of cleansing the wound occurs. The walls of the wound close to each other are glued together (primary gluing). Along with these processes, connective tissue cells multiply in the wound, which undergo a series of transformations and turn into fibrous connective tissue - a scar. On both sides of the wound there are counter processes of new formation of blood vessels, which grow into the fibrin clot that glues the walls of the wound. Simultaneously with the formation of the 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 epidermis; subsequently the entire epithelial layer is completely restored.

Signs of wound suppuration correspond to the classic signs of inflammation, as a biological reaction of the body to a foreign agent: dolor (pain);

calor(temperature);

tumor (swelling, swelling);

rubor (redness);

functio lesae (dysfunction);

Types of wound healing. PMP for wounds.

Healing of wounds without the development of infection when the wound walls are close together primary healing (healing by primary intention).

The presence of a significant distance between the walls or the development of a purulent infection leads to wound healing through the granulation stage, or to secondary healing (healing by secondary intention) .

Distinguish three main stages of wound healing:

Resorption of dead cells, tissues and hemorrhages;

Development of granulations filling the tissue defect formed as a result of their death;

Scar formation from granulation tissue.

Separation is important course of the wound process into three phases, determined based on the study of morphological, biochemical changes, the type of exudate, the condition of the wound and the severity of the clinical picture.

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

Second phase (dehydration phase) - phase corresponds to the period of extinction of inflammation and cleansing of the wound

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

During the wound process there are distinguished: GRANULATION STAGE, - in the cleaned wound, granulation tissue begins to grow wildly (photo on the left), filling the entire wound cavity. And also the STAGE OF EPITHELIZATION - the growth of epithelium occurs along the periphery of the wound, gradually narrowing it, reducing its area (the same photo on the left). Epithelization of a granulating wound begins in the first days. The epithelium, multiplying, grows on granulation tissue. If it is young, with well-developed vessels, then epithelization is strong. If the granulations are covered with necrotic cells or coarse fibrous tissue has already formed, then the epithelium, growing, dies and epithelization is delayed, long-term non-healing wounds and ulcerating scars are formed.

Granulation tissue is a barrier separating the internal environment of the body from external influences. The wound discharge covering the granulations has pronounced bactericidal properties. Granulation tissue consists of very easily vulnerable cells and vessels, so even mild mechanical or chemical trauma (wiping with gauze, bandaging with a hypertonic solution, etc.) damages it. Such a violation of the integrity of granulation tissue opens the entrance gate for microbes.

Principles of wound treatment depending on the phase of the wound process. Primary surgical treatment. Drainage of wounds.

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

Common goals of wound care are:

1) the ability to anticipate and prevent the dangers of a wound;

2) reducing 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, development of microbes, tissue swelling, absorption of toxins.

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

Stages of the wound process: inflammation, regeneration, epithelization.

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.

INFLAMMATION

The stage is characterized by the presence of all the signs of a purulent wound process. In a purulent wound there are remnants of non-viable and dead tissue, foreign objects, contamination, 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: increased body temperature, weakness, headache, lack of appetite, etc.

Stage Treatment Objectives: drainage of the wound to remove pus, necrotic tissue and toxins; fight against infection. Wound drainage can be active (using devices for aspiration) and passive (drainage tubes, rubber strips, gauze pads and turundas moistened with water-salt solutions of antiseptics. Medicinal (medicinal) agents for treatment:

Hypertonic solutions:

The most commonly used solution by surgeons is 10% sodium chloride solution (the so-called hypertonic solution). In addition to it, 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 fluid. However, it has been established that their osmotic activity lasts no more than 4-8 hours, after which they are diluted with wound secretion and the outflow stops. Therefore, surgeons have recently abandoned hypertonic solution.

In surgery, various ointments based on fat and vaseline-lanolin are used; Vishnevsky ointment, syntomycin 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 ensure the outflow of wound secretions and become only a plug. At the same time, the antibiotics contained in the ointments are not released from the ointment compositions and do not have a sufficient antimicrobial effect.

The use of new hydrophilic water-soluble ointments - Levosin, levomikol, mafenide acetate, oflocaine - is pathogenetically justified. Such ointments contain antibiotics, which easily transfer from 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, so one dressing per day is enough for an effective effect on the wound.

Enzyme therapy (enzyme therapy):

To quickly remove 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, the enzymes remain active for no more than 4-6 hours. Therefore, for effective treatment of purulent wounds, bandages must be changed 4-5 times a day, which is practically impossible. This lack of enzymes can be eliminated by including them in ointments. Thus, Iruksol ointment (Yugoslavia) contains the enzyme pentidase and the antiseptic chloramphenicol. The duration of action of enzymes can be increased by immobilizing them in dressings. Thus, trypsin immobilized on napkins acts for 24-48 hours. Therefore, one dressing per day fully ensures the 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 common pathogens of surgical infections.

Of the new antiseptics, the following should be highlighted: iodopirone, a preparation containing iodine, is used for treating surgeons’ hands (0.1%) and treating wounds (0.5-1%); dioxidin 0.1-1%, sodium hypochloride solution.

Physical methods of treatment.

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

Application of laser.

In the inflammation phase of the wound process, high-energy or surgical lasers are used. With a moderately defocused beam of a surgical laser, pus and necrotic tissue are evaporated, thus completely sterile wounds can be achieved, which allows, in some cases, to apply a primary suture to the wound.

GRANULATION

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

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

These tasks are answered by:

a) ointments: methyluracil, troxevasin - 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) laser use - in this phase of the wound process, low-energy (therapeutic) lasers are used, which have a stimulating effect.

EPITHELIZATION

The stage begins after filling the bottom of the wound and its cavity with granulation tissue. Objectives of the stage: accelerate the process of epithelization and scarring of wounds. For this purpose, sea buckthorn and rosehip oil, aerosols, troxevasin - jelly, and 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 again to water-salt antiseptics. It is useful to ensure that the dressing dries to the surface of the wound. In the future, it should not be torn off, but only cut off at the edges as it detaches due to epithelization of the wound. It is recommended to moisten the top of such a bandage with iodonate or another antiseptic. In this way, small wounds under a scab can be healed with a very good cosmetic effect. In this case, no scar is formed.

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

a) artificial leather

b) 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 Thiersch

At all stages of treatment of purulent wounds, one should remember the state of the immune system and the need for its stimulation in patients of this category.

The first and main stage of wound treatment in a medical institution is primary surgical treatment.

Primary surgical treatment of wounds (PSW). The main thing in the treatment of wounds is their primary surgical treatment. Its goal is to remove non-viable tissues and the microflora found in them and thereby prevent the development of wound infection.

Primary surgical treatment of wounds:

It is usually performed under local anesthesia. Stages:

1. Inspection of the wound, cleaning the skin edges, treating them with an antiseptic (tincture of iodine 5%, do not allow it to get into the wound);

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

3. Final stop of bleeding;

3. Drainage of the wound, according to indications;

4. Primary suture of the wound (according to indications);

A distinction is made between early primary surgical treatment, carried out on the first day after injury, delayed - during the second day, and late - 48 hours after injury. The earlier the primary surgical treatment is performed, the greater the likelihood of preventing the development of infectious complications in the wound.

During the Great Patriotic War, 30% of wounds were not subjected to surgical treatment: small superficial wounds, through wounds with small entry and exit holes without signs of damage to vital organs and blood vessels, multiple blind wounds.

Primary surgical treatment must be immediate and radical, i.e. it must be performed in one stage and during the process non-viable tissue must be completely removed. First of all, the wounded are operated on with a hemostatic tourniquet and extensive shrapnel wounds, with wounds contaminated with soil, in which there is a significant risk of developing an anaerobic infection.

Primary surgical treatment of the wound consists of excision of its edges, walls and bottom within healthy tissues with restoration of anatomical relationships.

Primary surgical treatment begins with incision of the wound. Using a bordering incision 0.5 - 1 cm wide, the skin and subcutaneous tissue around the wound are excised and the skin incision is extended along the axis of the limb along the neurovascular bundle for a length sufficient to allow all blind pockets of the wound to be examined and non-viable tissue to be excised. Next, the fascia and aponeurosis are dissected along the skin incision. This provides a good inspection of the wound and reduces compression of the muscles due to their swelling, which is especially important for gunshot wounds.

After dissecting the wound, scraps of clothing, blood clots, and loose foreign bodies are removed and the excision of crushed and contaminated tissue begins.

The muscles are excised within healthy tissue. Non-viable muscles are dark red, dull, do not bleed when cut and do not contract when touched with tweezers.

When treating a wound, intact large vessels, nerves, and tendons should be preserved, and contaminated tissue should be carefully removed from their surface. (small bone fragments lying freely in the wound are removed, the sharp, devoid of periosteum, protruding ends of the bone fragments into the wound are bitten off with pliers. If damage to blood vessels, nerves, and tendons is detected, their integrity is restored. When treating a wound, careful stoppage of bleeding is necessary. If during surgical treatment of the wound non-viable tissue and foreign bodies are completely removed, the wound is sutured (primary suture).

Late surgical treatment is performed according to the same rules as the early one, but if there are signs of purulent inflammation, it comes down to removing foreign bodies, cleaning the wound from dirt, removing necrotic tissue, opening leaks, pockets, hematomas, abscesses, in order to provide good conditions for the outflow of wound fluid.

Tissue excision, as a rule, is not performed due to the risk of generalization of infection.

The final stage of primary surgical treatment of wounds is the primary suture, which restores the anatomical continuity of the tissue. Its purpose is to prevent secondary infection of the wound and create conditions for wound healing by primary intention.

The primary suture is placed on the wound within 24 hours after the injury. As a rule, surgical interventions during aseptic operations are also completed with a primary suture. Under certain conditions, purulent wounds are closed with a primary suture after opening subcutaneous abscesses, phlegmons and excision of necrotic tissue, providing in the postoperative period good conditions for drainage and long-term washing of wounds with solutions of antiseptics and proteolytic enzymes.

The primary delayed suture is applied up to 5–7 days after the initial surgical treatment of wounds until granulation appears, provided that the wound has not become suppurated. Delayed sutures can be applied as provisional sutures: the operation is completed by suturing the edges of the wound and tightening them after a few days, if the wound has not become suppurated.

In wounds sutured with a primary suture, the inflammatory process is mild and healing occurs by primary intention.

During the Great Patriotic War, primary surgical treatment of wounds was not performed in full due to the risk of developing infection - without applying a primary suture; Primary delayed, provisional sutures were used. When acute inflammatory phenomena subsided and granulations appeared, a secondary suture was applied. The widespread use of primary suture in peacetime, even when treating wounds at a later stage (12–24 hours), is possible thanks to targeted antibacterial therapy and systematic monitoring of the patient. At the first signs of infection in the wound, it is necessary to partially or completely remove the sutures. The experience of the Second World War and subsequent local wars showed the inappropriateness of using a primary suture for gunshot wounds, not only due to the characteristics of the latter, but also due to the lack of possibility of systematic observation of the wounded in military field conditions and at the stages of medical evacuation.

The final stage of primary surgical treatment of wounds, delayed for some time, is a secondary suture. It is applied to a granulating wound in conditions when the danger of wound suppuration has passed. The period of application of the secondary suture ranges from several days to several months. It is used to speed up the healing of wounds.

An early secondary suture is applied to granulating wounds within 8 to 15 days. The edges of the wound are usually mobile; they are not excised.

A late secondary suture is applied at a later date (after 2 weeks), when cicatricial changes have occurred in the edges and walls of the wound. Bringing the edges, walls and bottom of the wound closer together in such cases is impossible, so the edges are mobilized and scar tissue is excised. In cases where there is a large skin defect, skin grafting is performed.

Indications for the use of a secondary suture are: normalization of body temperature, blood composition, satisfactory general condition of the patient, and from the side of the wound, the disappearance of swelling and hyperemia of the skin around it, complete cleansing of pus and necrotic tissue, the presence of healthy, bright, juicy granulations.

Various types of sutures are used, but regardless of the type of suture, the basic principles must be observed: there should be no closed cavities or pockets left in the wound, adaptation of the edges and walls of the wound should be maximum. The sutures must be removable, and there should be no ligatures left in the sutured wound, not only from non-absorbable material, but also from absorbable material, since the presence of foreign bodies in the future can create conditions for suppuration of the wound. During early secondary sutures, granulation tissue must be preserved, which simplifies the surgical technique and preserves the barrier function of granulation tissue, which prevents the spread of infection to surrounding tissues.

Healing of wounds sutured with a secondary suture and healed without suppuration is usually called healing by primary intention, in contrast to true primary intention, since, although the wound heals with a linear scar, processes of scar tissue formation occur in it through the maturation of granulations.

Drainage of wounds

Wound drainage plays an important role in creating favorable conditions for the course of the wound process. It is not always carried out, and the indications for this procedure are determined by the surgeon. According to modern concepts, wound drainage, depending on its type, should provide:

Removing excess blood (wound contents) from the wound and thereby preventing wound infection (any training pitchfork);

Tight contact of wound surfaces, helping to stop bleeding from small vessels (vacuum drainage of spaces located under the flaps);

Active cleansing of the wound (with its drainage with constant postoperative irrigation).

There are two main type of drainage: active and passive (Fig. 1).

Types of wound drainage and their characteristics

Rice. left. Types of wound drainage and their characteristics

Passive drainage

It involves removing wound contents directly through the line of skin sutures and is able to provide drainage of only the superficial parts of the wound. This involves the application, first of all, of an interrupted skin suture with relatively wide and leaky suture spaces. It is through them that drainages are installed, for which parts of drainage pipes and other available material can be used. By spreading the edges of the wound, drainages improve the outflow of wound contents. It is quite clear that such drainage is most effective when installing drains taking into account the action of gravity.

In general, passive wound drainage is characterized by simplicity, the downside of which is its low efficiency. Drainage with a piece of glove rubber in the photo on the left. It is obvious that passive drainages are not capable of providing drainage to wounds that have a complex shape, and therefore can be used primarily for superficial wounds located in areas where the requirements for the quality of the skin suture can be reduced.

Active drainage

It is the main type of drainage of wounds of complex shape and involves, on the one hand, sealing the skin wound, and on the other, the presence of special drainage devices and tools for inserting drainage tubes (Fig. 2).

Standard devices for active wound drainage with a set of conductors for passing drainage tubes through tissue.

Figure 2. Standard devices for active wound drainage with a set of conductors for passing drainage tubes through tissue.

An important difference between the method of active wound drainage is its high efficiency, as well as the possibility of floor-by-floor drainage of the wound. In this case, the surgeon can use the most precise skin suture, the quality of which is completely preserved when the drainage tubes are removed away from the wound. It is advisable to select the exit locations for drainage tubes in “hidden” areas where additional pinpoint scars do not impair aesthetic characteristics (scalp, armpit, pubic area, etc.).

Active drains are usually removed 1-2 days after surgery, when the volume of daily wound discharge (through a separate tube) does not exceed 30-40 ml.

The greatest drainage effect is provided by tubes made of non-wettable material (for example, silicone rubber). The lumen of a polyvinyl chloride tube can quickly become blocked due to the formation of blood clots. The reliability of such a tube can be increased by preliminary (before installation in the wound) rinsing with a solution containing heparin.

Drainage of felon: a) drainage tube; b) inserting a tube into the wound; c) washing; d) removing the tube.

Refusal of drainage or its insufficient effectiveness can lead to the accumulation of a significant amount of wound contents in the wound. The further course of the wound process depends on many factors and can lead to the development of suppuration. However, even without the development of purulent complications, the wound process in the presence of a hematoma changes significantly: all phases of scar formation are lengthened due to the longer process of organizing an intrawound hematoma. A very unfavorable circumstance is a long-term (several weeks or even months) increase in the volume of tissue in the area of the hematoma. The extent of tissue scarring increases, and the quality of the skin scar may deteriorate.

Factors promoting wound healing:

General condition of the body;

Nutritional status of the body;

Age;

Hormonal background;

Development of wound infection;

Oxygen supply status;

Dehydration;

Immune status.

Types of wound healing:

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

Healing secondary intention- healing through suppuration;

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

Stages of wound dressing:

1. Removing the old bandage;

2. Inspection of the wound and surrounding area;

3. Toilet the skin surrounding the wound;

4. Toilet wound;

5. Manipulation of the wound and preparing it for application of a new dressing;

6. Applying a new bandage;

7. Fixation of the bandage (see section Desmurgy)

A purulent wound is a lesion of the skin and nearby tissues, accompanied by swelling, necrosis and the formation of purulent exudate. At the same time, toxic substances are released and penetrate the circulatory and lymphatic systems.

Intoxication of the whole body occurs - the temperature rises, fever, nausea, and general weakness appear.

Characterized by swelling and pain. The pain is described as tugging, bursting. They are so strong that the patient cannot sleep.

At the site of inflammation, pus and necrotic tissue are clearly visible.

Causes of purulent wounds

Modern surgery treats any wound as infected. Not all of them are accompanied by suppuration.

Education is influenced by a combination of many factors:

the presence of non-viable tissue in the lesion cavity;
blood stagnation;
presence of a foreign body;
pathogenic microorganisms in critical quantities.

Some bacteria especially contribute to suppuration:

Proteus;
staphylococci;
pneumococci;
streptococci;
pseudomonas;
coli;
Klebsiella;
dysentery bacteria.

In addition, salmonella can provoke the formation of pus.

The likelihood of a purulent process increases if the patient has autoimmune diseases (diabetes mellitus), old age, excess weight, or cardiovascular disease.

Even the time of year influences the development of pathology (in autumn, wound healing occurs slowly and suppuration forms).

The part of the body where the wound is located plays a big role. Injuries to the neck and head heal quickly, while injuries to the torso and buttocks heal somewhat more slowly. Injuries to the arms and legs heal poorly, but the feet are the worst.

It is foot wounds that are most often accompanied by a purulent-inflammatory process.

Symptoms of purulent wounds

The pathological process can be recognized by the appearance of the tissue - purulent contents form in the wound cavity or at the site of damage. Shortly before this, redness around the wound, swelling, bursting and tugging pain are noted.

Body temperature rises, in milder cases - only at the site of the lesion. There is a flow of blood to the wound, the functioning of the affected part is disrupted.

Swelling of nearby tissues has an elevated temperature, and a little further away it is cold. Long-term edema is associated with impaired lymph outflow.

The most important symptom is pus. It contains bacteria, dead leukocytes, fats, globulins, albumins, and necrotic tissue.

By the color of the pus, you can determine the bacteria that causes the suppuration.

Liquid green pus indicates infection with streptococcus, thick white or yellow - staphylococcus.
Pseudomonas aeruginosa is characterized by yellow pus that turns bluish-green when reacting with oxygen.
Anaerobic bacteria are distinguished by foul-smelling pus of an indeterminate brown color.
Infection with E. coli is confirmed by dirty yellow liquid pus.

Symptoms are also signs of general intoxication - the temperature rises, sweating, fever, headache, thirst appear.

Signs of intoxication are confirmed by laboratory tests: ESR increases, protein is present in the urine. Leukocytosis with a shift to the left is noted. In especially severe cases, bilirubin and urea increase in the blood, hematopoietic function is disrupted - anemia and leukopenia appear. Consciousness is impaired, the patient is delirious.

Phases of development of the wound process

In surgery, the following phases are considered:

Creams and ointments for the treatment of purulent wounds

Levomekol ointment
Methyluracil ointment
Argosulfan cream
Stellanin ointment Wundehil ointment

Any violation of the integrity of the skin can cause the formation of pus, swelling and tissue necrosis in the area of the damaged area. Treatment of purulent wounds is carried out with the help of special medications, you can use traditional methods, or resort to urine therapy.

Treat purulent wounds promptly

Causes of suppuration

If pathogenic bacteria penetrate into a stab, cut, chopped, lacerated wound or postoperative suture, the process of suppuration will begin. The process is accompanied by pain, swelling, the damaged tissue consists of dead cells, requires immediate medical treatment - otherwise gangrene may develop, and the affected limb will have to be amputated.

Reasons for the development of a purulent process:

penetration of pyogenic microbes into the wound - staphylococci, streptococci, Proteus, E. coli;
large lesions, deep wounds;
the presence of dead tissue, a foreign body, or blood clots in the wound cavity;
small but long hole for puncture wounds;
a peculiar reaction of the body to medications that are used for dressings.

Staphylococci - pyogenic microbes

The likelihood of developing a purulent process increases in the presence of diabetes mellitus, vascular pathologies, obesity, sexually transmitted diseases, in elderly people, people with weakened immune systems, and in the hot season.

Any accidental wound in surgery is considered infected, so even minor scratches and abrasions should be treated immediately, especially in children.

Types of purulent wounds

Purulent wounds can be open or closed, accompanied by a process of infiltration and necrosis. Most often, suppuration begins in random wounds and postoperative sutures can develop as a gangrenous type, occur in the form of phlegmon or an abscess.

The main types of purulent dermatological lesions:

boils - pus accumulates in the follicles and sebaceous glands, the problem most often develops in diabetics and overweight people;
carbuncles - an infectious process develops simultaneously in several hair follicles, the disease is diagnosed in older people, with endocrine diseases;
hidradenitis – inflammation of the sweat glands due to non-compliance with hygiene rules, careless shaving of the armpits;
abscess - occurs in places of puncture wounds, after injections, is accompanied by necrotic pathologies, the inflamed area is limited to the capsule;
phlegmon - a purulent-necrotic process occurs in the cellular space, the affected area does not have clear boundaries;
paronychia - inflammation of the periungual fold on the hands;
panaritium - pus accumulates in soft tissues, bones, joints of the legs, and fingers.

Collection of pus in the big toe

The color and consistency of pus allows us to identify the type of causative agent of the inflammatory process. White or light yellow discharge indicates a staphylococcal infection; when E. coli penetrates into the wound, the mass is liquid and has a brown-yellow color. Infection with staphylococcus is indicated by watery formations of a greenish-yellow color, brown mucus with a strong fetid odor - a sign of an anaerobic infection. A yellow exudate that turns brown when exposed to air appears when infected with Pseudomonas aeruginosa.

Symptoms of festering wounds

The main local signs of a purulent process are the presence of exudate of different colors in the wound, pain, local increase in temperature, redness and swelling around the wound.

When infected, a large amount of toxins enters the body, which leads to the appearance of signs of intoxication at a later phase of the development of the disease.

Signs of a purulent process:
increased sweating;
loss of appetite, nausea;
weakness, fever;
migraine, fever;
pain in the affected area is of a pressing or bursting nature;

sometimes a rash appears on healthy areas of the skin that are located near the source of inflammation.

The presence of a purulent and inflammatory process helps to identify a clinical blood test - the ESR increases, the leukocyte formula shifts to the left.

Excessive sweating may indicate wound suppuration

To eliminate purulent-necrotic processes, complex therapy is used, which is aimed at suppressing the growth of pathogenic microorganisms, eliminating pain, and accelerating the regeneration process. Most often, local treatment is used; in severe forms, antibiotics in tablet form should also be taken.

Local therapy

The use of external medications with various therapeutic effects is the main method of treating purulent wounds. Before applying the ointment or solution, the damaged area should be cleaned with warm water and soap and blotted with a soft cloth. For dressings, you can only use sterile gauze and bandages; wipe all instruments with alcohol.

How to treat festering wounds:

Enzyme-based drugs – Chymotrypsin, Streptokinase. With regular use, the affected area is gradually cleared of fibrin and dead tissue, the healing process is accelerated, these drugs increase the sensitivity of pathogens to antibiotics. The solution should be soaked into gauze, applied to the wound for an hour, and therapy should be carried out for 10 days.
– an ointment with a combined therapeutic effect, contains an antibiotic and an immunomodulator, helps to quickly remove pus. The product is used for compresses and applied directly to wounds. Duration of therapy is 4 days.
Ichthyol ointment is a safe antiseptic and analgesic that is suitable for the treatment of pregnant women and children over 12 years of age. Because its active components do not penetrate the bloodstream. The drug is applied under a bandage, dressing should be done every 8 hours.
Magnesia will help get rid of swelling - you need to soak a cotton pad with a medicinal solution and apply it to the inflamed area for 1.5–2 hours.
Lincomycin, gentamicin ointment - contain antibacterial components. They can be applied 2-3 times a day, the duration of therapy is determined by the doctor.
Sodium chloride solution - reduces the synthesis of purulent exudate, used for dressings, which need to be changed every 5 hours.
Dimexide is a solution for compresses with anti-inflammatory, analgesic, and antihistamine effects.
Powder Baneocin, Xeroform is a drying agent with an antibacterial effect, it stops bleeding well.
To eliminate signs of intoxication, you need to drink more warm liquids with a diuretic and immunomodulating effect - rosehip decoction, mint tea, lemon balm, lingonberry and cranberry juice.

Baneocin powder is an antibacterial agent

Folk remedies for quick healing

Non-traditional treatment methods help speed up the healing process, help eliminate inflammatory processes and strengthen local immunity. Folk remedies can only be used in combination with drug therapy; all therapeutic measures should be agreed upon with the attending physician.

How to get rid of festering wounds using folk methods:

Ointment for drawing out pus - grind 1 lower large leaf of aloe and a small carrot in a blender, add 20 ml of liquid honey and melted butter. Apply the mixture under the bandage and carry out the procedure 3-4 times a day.
Healing ointment from Juna - mix raw chicken yolk with 5 ml of honey and 15 g of wheat flour. Apply the composition to the source of inflammation, cover with a paper napkin and a protective bandage. The compress should be changed every 3 hours; in case of severe pathologies, the mixture can be left overnight.
Compress with an antiseptic effect - mix fresh onion puree and crushed grape leaves in equal proportions. Apply the paste to the inflamed area, secure with a bandage, change the bandages every 4 hours.
Chamomile decoction is one of the best natural antiseptics. To prepare the infusion, you need to brew 20 g of crushed raw materials with 220 ml of boiling water, leave in a closed, wrapped container for 2 hours. Soak gauze with the solution and apply to the wound for 45 minutes.
To quickly cleanse the wound of pus, you can use a saline solution - dissolve 30–40 g of salt in 1 liter of warm water, wash the infected areas 4–5 times a day.

Chamomile decoction is a natural antimicrobial agent

Purulent processes cannot be treated with essential oils - they can provoke an exacerbation of the pathology. During therapy, you need to stop eating peanuts and other allergenic foods, and alcoholic beverages.

Urine therapy in the treatment of purulent wounds

Urine has long been used as a wound-healing agent for the rapid elimination of purulent processes - an absolutely sterile liquid contains hormones, microelements, and well softens the crusts that appear during the healing process, but modern non-traditional treatment is also carried out using urinotherapy. Fresh urine meets all therapeutic requirements.

How to remove purulent processes using urine:

Soak a sterile bandage generously in urine and wrap tightly around the affected area.
Wet the bandage with urine without removing it as it dries.
The compress needs to be changed every 3-5 days, depending on the severity of the pathology.

Urine has healing properties

Treatment with urine is an effective way to eliminate purulent processes, but it is better to use it in extreme cases, when there are no medications or other means of therapy at hand.

Features of treatment of purulent wounds in diabetes

In the event of traumatic injuries, the immune system of a healthy person begins to suppress foreign bodies, which reduces the risk of developing infectious pathologies; in diabetics, the body performs these functions worse. In diabetes, the process of glucose breakdown slows down, which reduces the rate of regeneration, promotes the active growth of pathogenic microorganisms - all this leads to long-term non-healing wounds, trophic ulcers, nerve endings lose sensitivity, and without proper treatment, amputation will be required.

All the consequences of untimely treatment of wounds in diabetes can be seen in the photo.

Purulent wound on the leg with diabetes

How to heal wounds with diabetes quickly:
Solcoseryl - normalizes metabolic processes in tissues, accelerates the regeneration process;
Delaxin is a tannin-based ointment with a pronounced anti-inflammatory effect;
Fusicutan is an antibacterial drug for external use;
Zinc ointment – dries damaged areas, prevents suppuration;
Levomekol, Dioxyzol - significantly accelerate the healing process;
Baneocin - ointment and powder, the product is a strong antibiotic;
Ichthyol ointment is an anesthetic and disinfectant for lotions and compresses;

Vishnevsky ointment, streptocidal ointment - destroy pathogenic microbes, draw out pus.

Vishnevsky ointment destroys microbes well

All medications should be applied at least twice a day. Damaged areas should first be washed, dried, and treated with hydrogen peroxide.

Ointments for the treatment of purulent wounds in diabetes should not contain alcohol, salicylic acid, synthetic dyes and preservatives, or glycerin.

How to cure purulent sores in the mouth

Ulcers in the oral cavity can appear due to non-compliance with hygiene rules, against the background of infectious or fungal pathology, long-term use of medications, diabetes, and frequent stress. The best medications for treatment are Benzocaine ointment, Solcoseryl. If the wounds occur due to an exacerbation of herpes, Acyclovir, Famciclovir will help.

Effective home therapies:
Cauterization. Rinse your mouth with a soda solution, apply hydrogen peroxide or Chlorhexidine to a sterile piece of cotton wool, and apply to the wound for 5 minutes. Carry out the procedure throughout the day at intervals of 5–6 hours.
Anesthesia and disinfection. Combine the juice of half a lemon with 3 g of soda, add 5 ml of cold water and liquid honey. Apply the composition to purulent wounds in the morning before breakfast and before bed.

Lemon juice and honey will help get rid of purulent sores in the mouth

If wounds in the mouth are accompanied by severe pain, a piece of ice can be used as first aid and pressed against the sore - this procedure will help prevent the development of inflammatory processes and quickly eliminate discomfort in the oral cavity.

Wound treatment after surgery

After any surgical intervention, sutures remain on the body, which should be properly cared for in order to avoid suppuration and speed up the healing process. Wound care includes the mandatory use of antiseptics and agents that accelerate the resorption of scars; medications should be used at least twice a day.

How can postoperative sutures be treated:

antibacterial and disinfectant solutions - iodine, alcohol, brilliant green, Fukortsin;
Vishnevsky ointment - draws pus from the wound, promotes rapid healing of wounds;
Levosin is an ointment with antibacterial and anti-inflammatory effects;
Actovegin – accelerates, eliminates inflammatory processes, normalizes blood circulation in tissues;
Naftaderm is a good pain reliever;
Levomekol ointment – accelerates healing, prevents skin drying;
– ointment for tightening scars;
Contractubex ointment, Mederma - can be used 2-3 months after surgery to eliminate scars.

If the wound has healed, you can additionally use sea buckthorn and milk thistle vegetable oil to soften the skin and tighten scars smoothly. The use of special plasters that secure the incision sites and prevent the growth of the scar is also effective.

You should not remove sutures and postoperative staples yourself - this is fraught with infection of the wound and the development of a purulent process.

Purulent wounds are a severe and complex pathology that requires long-term complex treatment. Only a doctor can determine which drug is better, the principle and treatment regimen, based on examination and the results of clinical studies. Self-medication can lead to the development of complications, including amputation of a limb.

LESSON PLAN #19

date according to the calendar and thematic plan

Groups: General Medicine

Number of hours: 2

Topic of the training session:

Type of training session: lesson on learning new educational material

Type of training session: lecture

Goals of training, development and education: To develop knowledge about the types of wounds, the clinical course of the wound process, the rules for providing primary care for wounds, 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 words and professional terms)

Upbringing: feelings and personality qualities (worldview, 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 primary care for wounds, principles of treatment depending on the phase of the wound process;indications for emergency prophylaxis of tetanus and rabies.

Logistics support for the training session: dressing material, set of tools for primary surgical treatment, suture removal,presentation, situational tasks, tests

PROGRESS OF THE CLASS

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

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

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

5. Fixing the material - 8 minutes:

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

2. Survey of students on the previous topic - 10 minutes .

7. Homework - 2 minutes . Total: 90 minutes.

Homework: 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: New Knowledge LLC, 2004

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

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 Belarus No. 109 “Hygienic requirements for the design, 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 and sterilization by healthcare institutions

Teacher: L.G.Lagodich

TEXT OF LECTURE

Subject: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. First aid for wounds. Principles of wound treatment depending on the phase of the wound process. Prevention of anaerobic infection.

5. Features of the treatment of puncture and bitten wounds. Emergency prevention of tetanus, prevention of rabies.

1. Wounds. Classification of wounds.

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

It is the violation of the integrity of the integumentary tissues (skin, mucous membrane) that distinguishes wounds from other types of damage (bruise, rupture, sprain). For example, a rupture of lung tissue that occurs as a result of blunt trauma to the chest is considered a rupture, and in the case of damage caused by a knife blow, it is considered a lung wound, because there is a violation of the integrity of the skin.

It is necessary to distinguish between the concepts of “wound” and “injury”. In essence, a wound is the end result of tissue damage. The concept of wounding (vulneratio) is understood as the process of injury 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 injury and in the entire body. However, in everyday practice, the terms wound and injury often replace each other and are often used as synonyms.

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 tissue, the characteristics of the innervation and blood supply to the wound canal area, and the possibility of injury to vital organs.

Elements of any wound are:

Wound cavity (wound canal);

Walls;

Bottom of the wound.

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

Wounds are classified according to various criteria.

1. According to the nature of tissue damage:

Puncture wounds inflicted with a piercing weapon (bayonet, needle, etc.). Their anatomical feature is significant depth with little damage to the integument. With these wounds, there is always a danger of damage to vital structures located deep in the tissues, in cavities (vessels, nerves, hollow and parenchymal organs). The appearance of puncture wounds and discharge from them do not always provide enough data to make a diagnosis. Thus, with a puncture wound to the abdomen, injury to the intestine or Liver is possible, but 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 there may be no connection with muscle contraction and displacement of the wound channel. 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 thorough examination of the patient’s wound is necessary, also because microorganisms are introduced into the depths of the tissue with the wounding weapon, and the wound discharge, without finding a way out, serves as a good nutrient medium for them, which creates especially favorable conditions for the development of purulent complications.

Incised wounds applied with a sharp object. They are characterized by a small number of destroyed cells; surrounding Pishi are not damaged. The gaping of the wound allows for inspection of damaged tissues and creates good conditions for the outflow of discharge. With an incised wound, there are the most favorable conditions for healing, therefore, when treating any fresh wounds, they strive to turn them into incised 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 surrounding tissues, reducing 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 a violation of their viability. Bruised blood vessels often become rhombus. Bruised wounds create favorable conditions for the development of infection.

Scalped woundswounds tangent to the surface of the body, inflicted by a sharp cutting object. If the flap remains on the leg, then such a wound is calledpatchwork.

Bite wounds are characterized not so much by extensive and deep damage, but by severe infection by the virulent flora of the mouth of a person or animal. The course of these wounds is more often than others complicated by the development of acute infection. Bite wounds can become infected with the rabies virus.

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

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

I distinguish the following elements of a gunshot wound:

-input(less) and day off(more) holes;

- wound channel zone - zone of direct impact of a traumatic projectile; In the wound canal zone there are:

- bruise area- zone of primary traumatic necrosis;

- molecular shock zone- zone of secondary necrosis;

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

2. Due to wound damage divided into:

Operational (intentional);

Random.

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

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, synovial membrane and joint capsule). 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. Simple and complicated wounds are distinguished , in which there is any additional tissue damage (poisoning, burn) or a combination of soft tissue injuries with damage to bone, hollow organs, etc.

2. Phases of the wound process, clinical manifestations.

Course of the wound process

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 condition of the wound and the severity of the clinical picture.

Morphologically they are distinguished:

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

Second phase (dehydration phase) - 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:

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

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

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

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

Dolor (pain);

Calor (temperature);

Tumor (swelling, swelling);

Rubor (redness);

Functio lesae (dysfunction);

Thus:

Types of wound healing:

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

Healing secondary intention- 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 formed as a result of their death;

Scar formation from granulation tissue.

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

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

Common goals of wound care are:

1) the ability to anticipate and prevent the dangers of a wound;

2) reducing 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, development of microbes, tissue swelling, absorption of toxins.

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

Clinical phases of the wound process:

Inflammation;

Regeneration:

Epithelization.

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 treatment of wounds (PSW):The video is shown upon patient admission,usually under local anesthesia.

Stages of PHO:

1. Inspection of the wound, cleaning the skin edges, treating them with an antiseptic (tincture of iodine 5%, do not allow it to get into the wound);

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

3. O final stop of bleeding;

3. Drainage of the wound, according to indications;

4. Primary suture of the wound (according to indications);

INFLAMMATION

Stage Treatment Objectives : drainage of the wound to remove pus, necrotic tissue and toxins; fight against infection. Wound drainage can be active (using devices for aspiration) and passive (drainage tubes, rubber strips, gauze pads and turundas moistened with water-salt solutions of antiseptics. Medicinal (medicinal) agents for treatment:

Hypertonic solutions:

Ointments:

The use of new hydrophilic water-soluble ointments - Levosin, levomikol, mafenide acetate - is pathogenetically justified. Such ointments contain antibiotics, which easily transfer from 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, so one dressing per day is enough for an effective effect on the wound.

Enzyme therapy (enzyme therapy):

Use of antiseptic solutions.

Physical methods of treatment.

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

Application of laser.

REGENERATION

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

These tasks are answered by:

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

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

EPITHELIZATION

The stage begins after filling the bottom of the wound and its cavity with granulation tissue (see figure). Objectives of the stage: accelerate the process of epithelization and scarring of wounds. For this purpose, sea buckthorn and rosehip oil, aerosols, troxevasin - jelly, and 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 again to water-salt antiseptics. It is useful to ensure that the dressing dries to the surface of the wound. In the future, it should not be torn off, but only cut off at the edges as it detaches due to epithelization of the wound. It is recommended to moisten the top of such a bandage with iodonate or another antiseptic. In this way, small wounds under a scab can be healed with a very good cosmetic effect. In this case, no scar is formed.

a) artificial leather

b) 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 Thiersch

At all stages of treatment of purulent wounds, one should remember the state of the immune system and the need for its stimulation in patients of this category.

Factors promoting wound healing:

General condition of the body;

Nutritional status of the body;

Age;

Hormonal background;

Development of wound infection;

Oxygen supply status;

Dehydration;

Immune status.

Stages of wound dressing:

1. Removing the old bandage;

2. Inspection of the wound and surrounding area;

3. Toilet the skin surrounding the wound;

4. Toilet wound;

5. Manipulation of the wound and preparing it for application of a new dressing;

6. Applying a new bandage;

7. Fixation of the bandage (see section Desmurgy)

5. Features of the treatment of puncture and bitten wounds. Emergency prevention of tetanus, prevention of rabies.

Features of a puncture wound is a small entrance hole and a deep wound channel. What does it mean? This means that the infection, especially an anaerobic one, immediately finds itself in optimal conditions for its development. This is a dangerous complication of the wound process - gas gangrene.The peculiarity of the treatment is wide dissection of the wound and drainage.

Features of a bite wound: a wound with torn, raw edges, deep punctures by teeth and infection with a severe infection that is always in the mouth, injury to soft tissues by the jaws. All this ensures almost 100% suppuration and various complications of the wound process (tetanus, rabies). ABOUTtreatment features: thorough primary surgical treatment of wounds, washing first with warm water and soap, then with antiseptics and high-quality drainage. Wounds cannot be stitched up! Mandatory - addressing the issue of emergency rabies immunoprophylaxis

Prevention of anaerobic infection.

Tetanus is a fatal disease that belongs to the class of anaerobic infections. Therefore, the only way to combat it is to prevent tetanus. It begins in childhood in several stages. AC drugs, DPT vaccines, ADS, etc. Our child is considered to be primarily vaccinated. Adults are revaccinated once every 10 years for life. But which adult does this?

Anaerobic infection is a specific surgical infection caused by clostridia. This type of microbe is anaerobic. Widely distributed in nature, especially in the soil, intestines of animals and humans.They cause a serious complication of the wound process in the form of gas gangrene.Therefore, the wounds that are most dangerous for gas gangrene are deep wounds contaminated with soil, with massive damage to soft tissue.

Prevention:

1. Early adequate surgical treatment of open injuries, wide drainage of the wound with tubular drainages and flow-through rinsing (continuous or fractional) with oxygen-releasing solutions (oxidizing agents: potassium permanganate, hydrogen peroxide). Immobilization.

2. Administration 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. Administration of polyvalent anti-gangrenous serum, prophylactic dose of 30 thousand IU (10 thousand units each against Cl. Perfringens, Cl. Novi, Cl. Septicum).

4. Anaerobic bacteriophage 100 ml. diluted 100 ml. 0.5% novocaine solution infiltrates the tissue around the wound.

Emergency prevention of tetanus, prevention of rabies.

Tetanus.

Planned immunoprophylaxis

Emergency prophylaxis of tetanus is regulated: regulatory document - see below

Rabies.

Emergency prevention of rabies, its regimens are prescribed depending on:

1. Bite sites: bites to the head and fingers are considered severe;

2. Whether the bite was provoked or not. An unprovoked bite is suspicious for rabies;

3. An animal, known or not, healthy, died, disappeared, killed. If veterinary control over the animal is impossible, vaccinations against rabies are prescribed unconditionally;