Cadaveric spots. Ultrasound assessment of multiple organ changes in children with renal failure
IMBIBITION , imbibitio (from Latin imbibe - re-absorb), soaking. The term I. is usually used to denote the impregnation of some denser material with a particular liquid medium; at the same time, however, in physical In a sense, the mechanism of this impregnation may be different. In some cases, we can talk about molecular absorption, assuming that the impregnation mechanism is based on molecular adsorption of liquid by dense material; in other cases, the penetration of liquid into the tissue occurs according to the laws of capillarity (capillary I.); in third cases, one can think of the swelling of colloids as the basis of I. Often one can also assume a combination of the above factors. In particular, impregnation of fabrics with certain artificial coloring substances (I. paint) can be attributed to I.; further, when certain integuments or other materials (for example, necrotic Peyer's patches in typhus) are impregnated with bile, they speak of I. bile; soaking tissues with transudating fluid during edema is also I. - Finally, in pathology, anatomy and forensic medicine, cadaveric I. is of great importance, i.e., soaking the tissues of a corpse with decomposing blood. The essence of this phenomenon comes down to the fact that during cadaveric decomposition of blood, Hb is leached from erythrocytes and appears dissolved in plasma; in connection with this, the inner surface of the vessels and cavities of the heart containing blood and blood clots is exposed to oxygen dissolved in the plasma of Hb, which is expressed in the coloring of these parts in a dirty red color. Subsequently, due to the penetration of Hb-stained plasma through the walls of the vessels into the surrounding tissue, plasma is absorbed by Hb in soft tissues located along the vessels. The latter kind of phenomenon is observed first of all and is most pronounced in those places where there are cadaveric hypostases; when the corpse is positioned on the back, such a place is the skin of the posterior surface of the torso and limbs, on which, as a result of I., a peculiar network of brownish-purple stripes appears along the veins stretched with blood. Near the jugular veins (bulbus ven. jugul.) there is also a noticeable limited penetration of loose tissue, reminiscent of a bruise. Among the internal organs of cadaveric I., the posterior parts of the lungs, the underlying loops of intestines, the posterior wall of the stomach, the kidneys, the membranes and the substance of the brain in their posterior parts are affected. In particular, in the lungs, with pronounced I., the posterior parts become almost black and airless, and on the back wall of the stomach from I. along the blood-filled veins, coffee-colored stripes appear due to changes in Hb under the influence of the acidic contents of the stomach. Cadaveric I., which belongs to the group of cadaveric changes, usually begins to appear on the corpse 12-15 hours after death; however, cadaveric I. reaches its full development, expressed in the appearance of the above network on the skin of the posterior parts of the corpse and sharp changes in the posterior parts of the lungs and other internal organs, only after 3-4 days. On the other hand, however, on the corpses of persons who died from septic processes, especially when storing the corpse in a warm room, very intense manifestations of cadaveric I. occur within a few hours. - Forensic medical. From the point of view of the phenomenon of cadaveric I. they are important because in some cases they help to judge the time that has passed since the moment of death. In addition, familiarity with changes depending on I. is necessary for forensic medicine. expert in view of the fact that such changes can sometimes simulate intravital hemorrhages from injuries, and in the lungs, pneumonia.
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Security questions
1. List the features of traumatic injuries to the maxillofacial area.
2. What is meant by the concept of “discrepancy between the appearance and severity of damage”? What is the practical significance of this concept?
3. What vital organs and functions are affected by traumatic injury to the maxillofacial area?
4. The presence of what anatomical formations fundamentally distinguishes the maxillofacial region from other areas of the human body?
5. What feature do the vessels of the maxillofacial region have in contrast to the vessels of other areas of the body?
6. What features of the soft tissues of the maxillofacial area contribute to increased regeneration?
7. What are the positive and negative aspects associated with having teeth?
8. Is it possible to use a conventional gas mask for a wounded person, and if not, then why and what is used?
Chapter 3
GENERAL CHARACTERISTICS OF TRAUMATIC SOFT TISSUE DAMAGE MAXILLOFACIAL AREA
Soft tissue injuries can be open or closed.
Open injuries are considered injuries that are accompanied by a violation of the integrity of the integumentary tissues, which include the skin and mucous membrane. These injuries are referred to as a wound. A wound has three main signs - pain, bleeding and gaping (divergence of the edges). A closed injury is characterized by two signs - pain and bleeding. In this case, there is no gaping of the edges of the wound of the skin or mucous membrane. Closed soft tissue injury is manifested by bruises, which are the result of a mild blow to the face with a blunt object with damage to the subcutaneous tissue, facial muscles without tearing them and the vessels located in the affected area. There are two possible bleeding options:
– with the formation of a cavity – when blood flows into the interstitial space, in this case a hematoma is formed;
– imbibition of tissues with blood, that is, saturation of them without the formation of cavities.
Depending on the location, hematomas can be superficial or deep. Superficial hematomas are located in the subcutaneous tissue, and deep hematomas are located in the thickness or under the muscles (for example, under the masseter, temporal), in deep spaces (for example, the pterygomaxillary, in the infratemporal fossa, in the area of the canine fossa), under the periosteum.
Superficial hematoma and imbibition of tissue by blood is manifested by a change in skin color. The skin over the hematoma initially has a purplish-blue or blue color (“bruise”). This color is due to the breakdown of red blood cells with the formation of hemosidirin and hemotoidin. Over time, the color changes to green (after 4–5 days), and then yellow (after 5–6 days); the hematoma finally resolves after 14–16 days.
A hematoma located in the pterygomaxillary, masseteric or subtemporal spaces can cause difficulty opening the mouth. A hematoma formed in the pterygomaxillary, peripharyngeal, sublingual areas and the area of the tongue root can lead to difficulty swallowing. All of the above hematomas are deep, which is why their diagnosis, i.e., determining the presence of hematomas in the indicated spaces, can be difficult.
The presence of a hematoma in the area of the canine fossa, due to compression of the lower orbital nerve, can cause a violation of sensitivity in the area of innervation by this nerve (the skin of the infraorbital region and the wing of the nose, the incisors of the upper jaw), which should be taken into account in the differential diagnosis of a hematoma with a fracture of the upper jaw along the lower orbital edge.
Hematomas in the area of the mental foramen may also be accompanied by loss of sensation in the area of the chin and lower lip of the corresponding side, which should be taken into account in the differential diagnosis between a soft tissue contusion and a fracture of the lower jaw in this area.
Deeply located hematomas may appear on the skin after 3–4 days. Hematoma is always accompanied by post-traumatic edema. It especially manifests itself in case of injury in the eyelid area. At the same time, it should be remembered that when the infraorbital region is damaged, swelling of the eyelids often occurs not only due to hematoma, but also due to compression of the lymphatic vessels that provide lymphatic drainage, which in turn leads to lymphostasis and swelling of the eyelids. As a result, a hematoma can have three development options: resorption, encapsulation and suppuration. In the second and third cases, drainage of the hematoma is necessary in a hospital setting, followed by anti-inflammatory treatment.
Closed trauma includes skin abrasions, when only the epidermis of the skin is damaged, and superficial damage to the oral mucosa.
3.1. Clinical characteristics of non-gunshot injuries of the maxillofacial area
Characteristics of non-gunshot wounds:
– the wound channel is usually smooth, there is no tissue defect, with the exception of lacerations, bruises and bite wounds;
– the zone of primary necrosis depends on the type of weapon;
– the zone of secondary necrosis is associated with the development of inflammatory processes, the presence of a soft tissue defect, concomitant damage to the bones of the facial skeleton, impaired blood circulation and innervation;
– the severity of the damage is determined by the area of contact of the weapon with soft tissues, the type of weapon, the force and speed of the blow, and the structure of the tissues.
Incised wounds can be caused by a straight razor, safety razor blade, glass shards, a knife or other cutting objects.
The nature of the wound in this case differs significantly from the nature of a gunshot wound. The inlet and outlet openings are usually the same size, the wound canal is smooth, and the tissue along the wound canal is rarely necrotic. The edges of the wound are well brought together and juxtaposed. The edges of damaged blood vessels and nerves are smooth, which greatly facilitates their detection and subsequent ligation or suturing. Penetrating wounds into the paranasal cavities and oral cavity should also be classified as through wounds. In terms of severity, through wounds of the soft tissues of the face are lighter than blind ones. However, if the muscles involved in the movement of the lower jaw, large vessels (facial and lingual arteries), soft palate, large salivary glands (parotid, submandibular, sublingual) are damaged, the clinical course of the injury should be assessed as moderate.
Puncture wounds occur after injury with a sharp, thin weapon (stiletto, needle, bayonet, awl) or any other weapon with a long, thin body. The peculiarity of puncture wounds is that with small visible damage their depth can be significant. The wound channel can affect not only muscles, but also deep-lying vessels, nerves, salivary glands, spaces of the maxillofacial region and cavities. That is why a thorough inspection of the wound and examination of the patient is necessary. Puncture wounds are often accompanied by the development of deeply located purulent processes (cellulitis, abscesses), which is facilitated by infection of the wound, the absence of wound discharge due to the small size of the inlet, and the presence of an interstitial hematoma, which forms in depth and is a good breeding ground for the development of purulent processes.
Chopped wounds. The nature of the chopped wound depends on the sharpness of the chopping weapon, its weight and the force with which the injury was inflicted. Chopped wounds are the result of a blow from a heavy sharp object (for example, an ax). They are characterized by a wide gaping wound, bruising and concussion of tissues, and may be accompanied by damage to the bones of the facial skeleton with the formation of fragments.
Bruised and lacerated wounds- the result of impact from a blunt object. They are characterized by the presence of crushed tissue. The edges of such wounds are uneven. There may be a tissue defect, as well as damage to the bones of the facial skeleton. Blood vessels often become thrombosed, which in turn leads to disruption of the blood supply to the affected area and to necrosis. Hematomas may occur. The course of such wounds due to infection and impaired blood supply is accompanied by the development of the inflammatory process. In this case, the wound heals by secondary intention, scars form, which leads to facial disfigurement. A bruised wound can be patchy.
Bite wounds occur when soft tissue is damaged by human or animal teeth. Characteristic signs of bite wounds are damage in the form of two arcs; in the center - oblong-shaped segments, and at the edges - rounded (funnel-shaped) from the fangs. Bite wounds are characterized by ragged edges, often accompanied by tissue defects, especially protruding parts of the face - nose, lips, ears, and tongue, and a high degree of infection. Complicated wounds heal by secondary intention with the formation of deforming scars. In case of soft tissue defects, plastic surgery is necessary. The pathogens of syphilis, tuberculosis, HIV infection, etc. can be transmitted through a bite.
When bitten by animals (dog, cat, fox, etc.), infection with rabies or glanders (horse) can occur. Therefore, it is necessary to find out which animal caused the bite (domestic, stray or wild). In all cases in which it is impossible to determine the condition of the animal, immunization against rabies is necessary, which is carried out by a trauma surgeon who has special training in providing anti-rabies care to the population. Immunization is carried out in outpatient or inpatient settings in accordance with the instructions for the use of anti-rabies drugs.
Non-gunshot wounds can be combined with the presence of a foreign body in the wound. This could be glass, brick, soil, pieces of wood, i.e. those materials that were at the site of the damage. In dental practice, a foreign body can be an injection needle, burs, teeth, or filling material. Their localization is possible in soft tissues, the maxillary sinus, and the mandibular canal. Endodontic instruments should also be considered a foreign body: drill bur, K-file, H-file, channel filler, pulp extractor, spreader, etc.
3.2. Clinical characteristics of gunshot injuries of the maxillofacial area
In the mechanism of formation of a gunshot wound, four factors are of primary importance:
– shock wave impact;
– impact of a wounding projectile;
– exposure to the energy of a side impact, during which a temporarily pulsating cavity is formed;
– impact of the wake vortex.
In case of non-gunshot wounds and damage, only one of four factors matters - the impact of the wounding projectile. Gunshot wounds, unlike non-gunshot wounds, are characterized by tissue destruction not only in the area of the wound canal (primary necrosis), but also beyond it with the formation of new foci of necrosis within several days after the wound (secondary necrosis). Three damage zones can be distinguished:
– wound channel zone;
– zone of contusion or zone of primary necrosis, i.e. zone of simultaneous necrosis of soft tissues due to direct impact;
– zone of commotion (lat. commotio- concussion) or a zone of molecular concussion associated with the action of the force of kinetic energy that occurs when using high-velocity small arms. As a result, a pulsating high-pressure cavity is formed, tens of times larger in diameter than the wound channel and 1000–2000 times longer than the time of passage of the wounding projectile. This explains the appearance of areas of secondary necrosis, which is focal in nature.
The clinical picture of damage to the soft tissues of the maxillofacial region largely depends on the type and shape of the wounding object. Gunshot wounds, unlike non-gunshot wounds, are more severe and are often accompanied by damage to the bones of the facial skeleton, soft tissue defects, and disruption of vital functions (breathing, chewing, etc.).
According to data obtained from a comparative analysis of gunshot wounds of the maxillofacial area during the Second World War and modern LVK, their frequency, depending on the nature of the damage, is distributed as follows:
– end-to-end – 14.6% (VOV) and 36.5% (LVK);
– blind – 79.6% (VOB) and 46.2% (PWD);
– tangents – 5.7% (BOB) and 14.4% (DEF);
The increase in through-and-through gunshot wounds in the LVK compared to the WWII period can be explained by the increasing proportion of the use of high-velocity firearms.
More severe gunshot wounds are through and through. They are characterized by the presence of an inlet, a wound channel and an outlet. While the inlet hole may be small, the outlet hole is several orders of magnitude larger than the inlet hole. This is explained by the fact that when a bullet with a displaced center of gravity is introduced into the body, it, passing through the tissue, turns over and comes out in a transverse position. The presence of a pulsating cavity and the development of kinetic energy leads to extensive destruction along the wound channel. A large amount of necrotic tissue is formed, the edges of blood vessels and nerves are crushed.
Blind wounds are characterized by an entry hole, a wound channel, and a foreign body.
Foreign bodies are classified according to the following criteria:
1. In relation to Rg rays:
– radiopaque;
– not radiopaque.
2. By location:
– in subcutaneous tissue, in muscles;
– with bone damage;
– in the paranasal cavities;
– in the deep spaces of the maxillofacial region (pterygomaxillary, peripharyngeal, floor of the oral cavity);
– in the thickness of the tongue;
3. By type of wounding projectile:
- fragment;
– teeth that are outside the sockets (secondary wounding projectiles);
- other.
Reasons requiring mandatory removal of a foreign body:
– the foreign body is in the plane of the fracture;
– a foreign body is located near the vessels, which can lead to the development of pressure sores of the vessel wall and the occurrence of secondary early and sometimes late bleeding;
– presence of constant pain;
– restriction of movement of the lower jaw;
– breathing problems;
– prolonged inflammation;
– presence of a foreign body in the paranasal cavities.
The timing and location of foreign body removal depend on the environment in which the injury was sustained. During military operations, the operation to remove a foreign body is determined by the military and medical situation and evacuation conditions.
V.I. Voyachek (1946) identifies four combinations of the ratio of local and general reactions to the presence of a foreign body, on which the time of its removal depends:
1) easy access to a foreign body in the absence of unpleasant consequences associated with it (extraction is carried out under favorable conditions);
2) easy access, but there is a pronounced local or general reaction (removed at the first opportunity);
3) difficult access, but there is no reaction to a foreign body (removed only for special reasons);
4) difficult access, but in the presence of unpleasant sensations or threatening symptoms (removed with the necessary precautions).
In connection with the above, indications for the removal of foreign bodies can be divided into conditional, absolute and relative.
If the presence of a foreign body is safe, does not cause functional impairment and can be easily removed, then such indications relate to conditional and foreign body removal can be performed at any time and at any stage of medical evacuation depending on the medical and military situation.
If removal of a foreign body is not difficult, but its presence is life-threatening, then the indications for its removal are absolute. In this case, the operation is carried out as soon as possible.
If the removal of a foreign body is technically difficult and can lead to greater complications than the presence of the foreign body itself, then the removal is carried out with the provision of qualified or specialized care and then the indications for removal of the foreign body can be considered relative.
In peacetime, the wounded person is taken to a hospital, where he should receive specialized care to remove the foreign body. In the preoperative period, an X-ray examination is necessary. During a standard examination, two X-ray photographs are necessarily taken in two projections - frontal and lateral, in order to determine the localization of the body in space in relation to anatomical landmarks. Other methods of X-ray examination are also possible: orthopantomogram, computed tomography, etc.
During primary surgical treatment, revision of the wound canal and the areas adjacent to it is mandatory. Visual detection of a foreign body is especially important when the presence of non-radiopaque materials is suspected. In the maxillofacial area, additional incisions are not possible to search for a foreign body. In addition to visual examination of the wound canal during primary surgical treatment, endoscopic examination can be used (Samoilov A. S. [et al.], 2006). In case of doubt about the presence of a foreign body, the application of a blind suture during primary surgical treatment is not recommended. A closed suture can be applied after 5–7 days, making sure that there is no inflammatory process. During the entire observation period, in order to reduce the gaping of the wound edges, it is possible to use strips of adhesive tape, apply lamellar or rare sutures (see Fig. 24, 25). In Fig. 4, 5, 6, 7, 8 show examples of foreign bodies of different types and locations.
The severity of damage to the soft tissues of the face depends on the location of the wound, the volume of tissue located in the area of damage, and the type of wounding projectile. However, for any wound, the course of the wound process is typical, which is divided into four periods. (Conditionally, because the transition from one period to another does not occur abruptly, but gradually. During one period, the development of another begins.)
First period is limited to 48 hours and is characterized by traumatic edema due to an increase in the permeability of the vascular wall. Traumatic swelling can last from 3 to 5 days. However, already during this period, signs of necrosis are detected in the muscles and subcutaneous tissue. The discharge from the wound is serous in nature, but by the end of the period the discharge is serous-hemorrhagic in nature, and then purulent.
Rice. 4. X-ray of the facial bones of the skull in a lateral projection. A fragment of a knife is visible in the upper jaw area
Rice. 5. X-ray in the lateral projection of the lower jaw. Gunshot wound with pellets
Rice. 6. X-ray in the lateral projection of the upper jaw. There is an injection needle in the maxillary sinus
Rice. 7. X-ray in the lateral projection of the mandibular ramus. Foreign body - bullet
Rice. 8. Survey radiograph in a direct projection of the skull. Foreign body - Osa system bullet in the maxillary sinus
Second period limited to a period of 3 to 7 days and is characterized by an inflammatory process. Any wound is infected, and wounds of the maxillofacial area can be additionally infected through the adnexal cavities of the nose, oral cavity (penetrating wounds), due to destroyed teeth. The discharge from the wound becomes serous-purulent, then purulent. During this period, purulent “streaks” and the spread of the purulent process into the deep spaces of the maxillofacial region (pterygomaxillary, masseter, root of the tongue, peripharyngeal, temporal and infratemporal fossa, along the neurovascular bundle of the neck into the mediastinum, etc.) are possible. By the end of this period, in case of gunshot wounds, tissues damaged at the submolecular level are demarcated from undamaged ones. Already during this period, phenomena characteristic of the next period are observed: endothelial proliferation occurs in the subcutaneous fatty tissue and muscles, new vessels are formed, which subsequently forms the basis for the development of granulation tissue. Towards the end of the period, cleansing of the wound begins.
Third period lasts 8–10 days and is characterized by wound cleansing and development of granulation tissue. At this time, contraction of the wound begins due to the formation of fibrous tissue from its edges.
Fourth period can last from 11 to 30 days and is characterized by epithelization and scarring. Granulation tissue transforms into collagen fibers and becomes denser. Scar organization and epithelization are underway. The epithelium is formed from the edges of the wound and cannot compete with the rate of development of collagen fibers, since the rate of its growth from the edges of the wound along the perimeter is no more than 1 mm in 7–10 days. This is what determines secondary wound healing, which is always characterized by the presence of a scar.
The course of the wound process of soft tissues of the maxillofacial region differs from wounds of other localizations. Due to anatomical and physiological characteristics, wound healing occurs in a shorter time. Good vascularization, innervation, and the presence of low-differentiated mesenchymal cells of the soft tissues of the face determine good regenerative ability, shorten the wound healing period and make it possible to increase the time of primary surgical treatment of the wound to 48 hours.
The duration of periods of wound healing and the severity of the course depend on factors such as:
– duration of assistance and its adequacy at the prehospital (inpatient) stage;
– general condition of the patient (age, dehydration, nutritional exhaustion, etc.);
– concomitant diseases (CVD, diabetes, chronic kidney disease, liver disease, etc.);
– collateral damage.
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All people, regardless of age, are susceptible to facial bruises. A relatively simple injury may conceal serious damage to the deep layers of facial tissue and bones of the facial skeleton, which can lead to complications.
Correctly provided first aid, timely consultation with doctors and adequate treatment tactics will help to avoid complications and aesthetic discomfort.
Bruise is a closed injury to tissue structures: subcutaneous fat, blood vessels and muscles without compromising the integrity of the skin. In this case, a complex of pathological changes occurs in the affected area. Local changes are characterized by sprains and ruptures of soft tissues, vascular injuries, hemorrhages and lymphatic bleeds, necrosis and disintegration of cell elements.
Bruises of facial tissues are characterized by hemorrhage, which has two development mechanisms:
- formation of a cavity in the interstitial space, filling it with blood;
- soaking tissues with blood without forming a cavity (imbibition).
This is how a hematoma (bruise) is formed - a limited accumulation of blood, often accompanied by post-traumatic swelling. Depending on the traumatic agent, the intensity of the injury and the location of the lesion, the hematoma can be located superficially or deeply.
In case of superficial hemorrhage, only the subcutaneous fatty tissue is affected; deep hematomas are characterized by their location in the thickness of the muscles or under the periosteum of the facial skeleton.
Causes and symptoms of bruises
The main causes of facial bruises: a fall from a height, a blow from a hard object, compression of facial tissue during road accidents or natural disasters.
The first sign of a facial injury is pain. This is a signal of damage or irritation of nerve fibers. The intensity of pain depends on the severity of the injury and the location of the affected area.
The most lasting pain occurs when the nerve trunks of the face are damaged. In this case, the injured person experiences sharp, burning and shooting pain. It intensifies with any movement of the facial muscles.
After exposure to a traumatic agent, the skin acquires a bright red tint. This is how the blood entering the interstitial space shines through the skin. Gradually its concentration increases, and the affected area changes color to blue-purple.
Gradually, the breakdown of hemoglobin begins in the hematoma. After 3-4 days, a breakdown product of blood cells, hemosiderin, is formed, which causes a green color, and on days 5-6 hematoidin, which is yellow in color.
This alternating change in the color of the hematoma is popularly called “blooming bruise.” In the absence of complications, the hematoma completely resolves within 14-16 days.
Reasons to immediately consult a doctor are the appearance of clear fluid from the ear, cyanosis (blue discoloration) of the area around the eyes, convulsions, loss of consciousness, nausea and vomiting. These are signs of a serious traumatic brain injury, requiring a detailed examination of the body and certain treatment tactics.
Classification of soft tissue bruises
In traumatology, bruises are classified according to severity. This allows you to determine treatment tactics and assess the possible risk of complications.
- 1st degree
Bruises are characterized by minor damage to the subcutaneous fat. They do not cause concern, do not require contact with a specialist and resolve on their own within 5 days. There may be minor pain and blue discoloration of the damaged area.
- 2nd degree
Severe damage to subcutaneous fat. Bruises are accompanied by hematoma, swelling and acute pain. In this case, complex treatment with pharmacological drugs is necessary.
- 3rd degree
A severe bruise affecting the muscles and periosteum is often accompanied by a violation of the integrity of the skin. There is a high risk of bacterial infection. In these cases, a visit to a traumatologist is mandatory.
- 4th degree
Rated as extremely severe. In this case, the functionality of the facial skeleton is impaired and the risk of complications from the brain is high. The condition of the injured person requires emergency medical attention.
First aid
It’s interesting that everyone has heard about the effect of cold on areas of injury. However, not everyone knows the mechanism of action of cold, so they often ignore this important point in providing first aid for bruises.
When exposed to cold, blood vessels narrow. This significantly stops hemorrhage into the interstitial space and causes the severity of the hematoma.
Cold suppresses the release of inflammatory mediators, reduces the sensitivity of the injured area, which affects the intensity of pain.
For cryotherapy use:
- ice cubes;
- cryopackages from the pharmacy;
- a towel soaked in cold water;
- any cold item from the refrigerator.
On average, the duration of a single exposure to cold on the injured area is 15-20 minutes. For severe bruises with persistent pain, the procedure is repeated every 2 hours.
In this case, you need to rely on subjective sensations and monitor the condition of the skin. She should be numb and red. Whitening of the injured area and adjacent tissues indicates a violation of local circulation due to a long-term state of vasoconstriction.
Cold treatment is contraindicated for pathological circulatory disorders and diabetes mellitus. Ice and cold objects are applied to the face only through a cloth. Direct contact can lead to frostbite of skin cells and the appearance of a pigmented area after necrosis.
If there are abrasions and wounds with bruises, the edges of the damaged area are treated with antiseptic agents:
- brilliant green;
- hydrogen peroxide;
- furatsilin;
- 0.01% potassium permanganate solution.
In the first 48 hours, do not apply heat or massage to the bruised area. To relieve severe pain, take oral analgesics: Ketanov, Nurofen, Ibuprofen.
Treatment complex
To treat bruises, external medications, light massage and heat therapy are used. During this period, avoid the use of alcohol, which dilates blood vessels, and medications that thin the blood.
Medicines
In pharmacies you can purchase medicines in the form of ointment, cream or gel with cooling, absorbent, regenerating and analgesic properties. Therefore, it is not difficult to cure a bruise and quickly get rid of a hematoma on the face. This review selects the most effective drugs.
Coolants
Medicines in this group contain menthol, essential oils, analgesics and other active substances. The drugs eliminate pain, reduce blood flow to the affected area, and prevent the formation of a bruise.
Preparations:
- Venoruton.
- Sanitas.
It is advisable to use medications within 48 hours after injury.
Absorbable and painkillers
The active substances of these drugs prevent thrombus formation, improve tissue trophism, help eliminate edema and resolve hematomas. Additionally, medications relieve pain, relieve itching, disinfect the affected surface and have an anti-inflammatory effect.
Preparations:
- heparin (heparin ointment, Lyoton, Flenox, Hepavenol plus, Dolobene, Panthevenol);
- badyaga (Badyaga forte, Doctor, Express Bruise);
- troxerutin (Venolan, Troxegel, Troxevasin, Febaton, Indovazin);
- Sinyakov-OFF;
- Rescuer;
- Traumeel S.
Before using the medicine, you need to study the instructions; some of them have specific contraindications.
The preparations are applied in a thin layer to cleansed skin using massaging movements. The number of repetitions depends on the activity of the drug, so you need to follow the instructions.
Preparations in gel form have some advantages over ointments. After using them, there is no oily shine on the face, clothes and bed linen get dirty relatively little. The active substances of these drugs are dissolved in a water base, so they penetrate the skin faster.
It is advisable to use ointments for very dry skin and crust formation on the wound surface. In these cases, the oily base softens the outer layers of the skin, allowing active components to reach the site of action.
Folk remedies used at home
Many plants and foods common in the daily diet contain components that can quickly heal bruises on the face. This method of treatment, harmless to the body, is suitable for bruises of the 1st and 2nd degree.
For treatment, components with anti-edematous, anticoagulant, and anti-inflammatory properties are used. Folk remedies improve tissue trophism, promote the resorption of blood clots, stimulate local immunity and metabolism, and have a moderate analgesic effect.
Cabbage, potatoes and burdock
For treatment, a green cabbage leaf is washed under cold water, several small cuts are made on the surface and applied to the site of the bruise. The compress can be secured with adhesive tape. The remedy is kept until the leaf dries, the procedure is repeated 4-6 times a day.
To enhance the anti-edematous effect, compresses with cabbage leaves can be combined with the application of raw potatoes. To do this, apply grated potatoes to the surface of the bruise, cover with gauze and leave to act for 30 minutes.
In summer you can use burdock leaf. It is washed with cold water, cuts are made and applied to the bruise with the light side.
Aloe and honey
To prepare the herbal remedy, select a large leaf of a plant that is at least 2 years old. The crushed raw materials are mixed with honey in equal proportions, placed in a glass container and stored in the refrigerator.
Every day, apply a thick layer of ointment to the surface of the bruise and cover it with gauze. The duration of the procedure is 20 minutes, the amount is 2-3 times a day.
If it is not possible to find aloe, the plant can be replaced with grated fresh beets.
Banana and pineapple
To reduce hematoma and swelling, it is enough to apply a banana peel or a slice of pineapple to the bruised surface. The duration of the compress is 30 minutes; to achieve a quick effect, you will need at least 4 procedures per day.
Apple cider vinegar
To prepare a medicinal solution, vinegar (2 tsp) is diluted in cold water (1 l). A gauze cloth soaked in the solution is applied to the bruise for 30 minutes 2-3 times a day.
Heat therapy
Exposure to heat stimulates local blood and lymph circulation, immunity and metabolism. This accelerates the processes of tissue cell restoration and hematoma resorption.
You can treat with heat 2 days after the injury. To achieve better results, procedures are combined with massage.
To apply the procedure at home, gauze cloth is folded into 5-6 layers, moistened in hot water and applied to the injured area. Plastic film and thick fabric are placed on top of the fabric. The exposure time is 15-20 minutes, the number of procedures is 2 times a day.
The warming effect of the compress is enhanced by 40% ethyl alcohol, vodka, camphor or salicylic alcohol. They are diluted with hot water.
Massage
Reflex and mechanical influences with the hands stimulate contraction of the muscles and subcutaneous tissues of the face. This improves blood circulation, microcirculation and metabolism. As a result, the processes of resorption of infiltrate, edema and hematoma are accelerated, and the risk of muscle atrophy is reduced.
6-8 hours after the injury, begin massaging the areas adjacent to the affected area. To do this, deep stroking, kneading and vibration techniques are used. The duration of the procedure is 10 minutes, the quantity is 2 times a day.
Massage of the bruised surface can be done only 48 hours after the injury, provided there are no ruptures of large vessels and an extensive wound surface.
In this case, only superficial stroking and vibration are allowed. The duration of the procedure is increased to 15 minutes.
Possible consequences of a bruise
The usual pain, hematoma and swelling may hide damage to the brain and facial skeleton. Ignoring a visit to a traumatologist and lack of timely treatment leads to serious consequences and complicates the life of the injured person in the future.
Possible consequences:
- traumatic brain injury;
- deformation of nasal structures;
- development of chronic rhinitis, sinusitis, sinusitis;
- violation of the breathing process;
- concussions of various degrees;
- fractures of the facial skeleton;
- perforation of the eardrum;
- infectious inflammation of the hematoma.
With an oblique blow, detachment of the subcutaneous tissue often occurs, contributing to the formation of a large and deeply located hematoma. As they harden, they form traumatic cysts. Such pathological formations can only be cured surgically.
How to disguise a hematoma?
Not all injured people are able to take time off from work or avoid going out to public places. Therefore, a bruise on the face often becomes a cause of acute distress and discomfort. In these cases, a few simple steps to mask the hematoma and relieve swelling can help.
Salt compress
This is the fastest way to eliminate post-traumatic swelling, but it is very harmful to the skin. Therefore, it is used only in extreme cases, when the appearance of the face needs to be put in order in a short time.
To prepare the product, salt (3 tbsp) is dissolved in warm boiled water (1 l). Dip a gauze cloth into the solution for 5 minutes so that it becomes saturated with salt crystals. The compress is applied to the bruise for 20 minutes, the skin is washed with warm water.
Concealers
These concealers are designed to hide skin imperfections. The main thing is to choose the right concealer color:
- with a fresh blue-purple bruise - orange;
- for green hematoma - yellow;
- with a yellow bruise - lilac, lavender.
It is better to mask large hematomas with a coverstick, and small bruises can be treated well with creams or pencils.
Many people are accustomed to treating facial bruises as a minor injury. Often, treatment comes down to applying cold and taking painkillers. The face is part of the craniofacial skeleton, inextricably linked with the brain, respiratory and hearing organs. Therefore, it is important to be attentive to facial injuries and bruises, including minor ones.
