PSO of the wound (primary surgical treatment): set of instruments, medications. Chapter xxi Primary surgical treatment of facial wounds

A wound is mechanical damage to tissue in the presence of violations of the integrity of the skin. The presence of a wound, rather than a bruise or hematoma, can be determined by such signs as pain, gaping, bleeding, dysfunction and integrity. PSO of the wound is performed in the first 72 hours after the injury, if there are no contraindications.

Types of wounds

Each wound has a cavity, walls and a bottom. Depending on the nature of the damage, all wounds are divided into puncture, cut, chopped, bruised, bitten and poisoned. This must be taken into account during PSO of a wound. After all, the specifics of first aid depend on the nature of the injury.

Puncture wounds always applied with a sharp object, such as a needle. Distinctive feature The damage is deep, but the damage to the integument is small. In view of this, it is necessary to ensure that there is no damage to blood vessels, organs or nerves. Puncture wounds are dangerous due to mild symptoms. So, if there is a wound on the abdomen, there is a possibility of liver damage. This is not always easy to notice when carrying out PHO.
An incised wound is made using sharp object, so tissue destruction is small. At the same time, the gaping cavity can be easily examined and PSO performed. Such wounds are treated well, and healing occurs quickly, without complications.
Chopped wounds are caused by a sharp but heavy object, such as an axe. In this case, the damage differs in depth, and is characterized by the presence of a wide gaping and bruising of adjacent tissues. Because of this, the ability to regenerate is reduced.
Bruised wounds occur when using a blunt object. These injuries are characterized by the presence of many damaged tissues, heavily saturated with blood. When performing PSW of a wound, it should be taken into account that there is a possibility of suppuration.
Bite wounds are dangerous due to the penetration of infection with the saliva of an animal, and sometimes a person. There is a risk of developing acute infection and the emergence of the rabies virus.
Envenomed wounds usually occur when there is a snake or spider bite.
differ in the type of weapon used, the characteristics of the damage and the trajectories of penetration. There is a high probability of infection.

When performing PST of a wound, the presence of suppuration plays an important role. Such injuries can be purulent, freshly infected and aseptic.

The purpose of the PHO

Primary surgical treatment is necessary to remove harmful microorganisms that got into the wound. To do this, all damaged dead tissue, as well as blood clots, are cut off. After this, sutures are placed and drainage is performed, if necessary.

The procedure is necessary if there is tissue damage with jagged edges. Deep and contaminated wounds require the same. Presence of major damage blood vessels, and sometimes bones and nerves also require surgical work. PHO is carried out simultaneously and exhaustively. The patient needs the help of a surgeon for up to 72 hours after the wound is inflicted. Early PSO is carried out during the first day, carried out on the second day - this is a delayed surgical intervention.

Tools for chemical and chemical treatment

To carry out the procedure primary processing wounds, a minimum of two copies of the set are required. They are changed during the operation, and after the dirty stage they are disposed of:

a straight forceps clamp, which is used to process the surgical field;
pointed scalpel, belly;
linen pins are used to hold dressings and other materials;
Kocher, Billroth and “mosquito” clamps are used to stop bleeding; when performing PSO of a wound, they are used in huge quantities;
scissors, they can be straight, as well as curved along a plane or edge in several copies;
Kocher probes, grooved and button-shaped;
set of needles;
needle holder;
tweezers;
hooks (several pairs).

The surgical kit for this procedure also includes injection needles, syringes, bandages, gauze balls, rubber gloves, all kinds of tubes and napkins. All items that will be needed for PSO - suture and dressing kits, tools and medications, intended for treating wounds, are laid out on the surgical table.

Necessary medications

Primary surgical treatment of a wound is not complete without special medications. The most commonly used are:

Stages of PHO

Primary surgical treatment is carried out in several stages:

How is PHO done?

For surgical intervention the patient is placed on the table. Its position depends on the location of the wound. The surgeon should be comfortable. The wound is cleaned and the surgical field is treated, which is delimited by sterile disposable linen. Next is executed primary intention, aimed at healing existing wounds and anesthesia is administered. In most cases, surgeons use the Vishnevsky method - they inject a 0.5% novocaine solution at a distance of two centimeters from the edge of the cut. The same amount of solution is injected on the other side. At correct reaction The patient has a “lemon peel” on the skin around the wound. Gunshot wounds often require the patient to be put under general anesthesia.

The edges of the damage up to 1 cm are held with a Kochcher clamp and cut off en bloc. When performing the procedure, non-viable tissue is cut off on the face or fingers, after which a tight suture is applied. Gloves and tools used are replaced.

The wound is washed with chlorhexidine and examined. Puncture wounds, which have small but deep cuts, are dissected. If the edges of the muscles are damaged, they are removed. Do the same with bone fragments. Next, hemostasis is performed. Inner part wounds are treated first with a solution and then with antiseptic drugs.

The treated wound without signs of sepsis is sutured tightly with primary and covered with an aseptic bandage. The seams are made, uniformly covering all layers in width and depth. It is necessary that they touch each other, but do not pull together. When performing the work it is necessary to obtain cosmetic healing.

In some cases, primary sutures are not applied. An incised wound may have more serious damage than it seems at first glance. If the surgeon has doubts, a primary delayed suture is used. This method is used if the wound has become infected. The suturing is carried out down to the fatty tissue, and the sutures are not tightened. A few days after observation, until the end.

Bite wounds

PCS of a wound, bitten or poisoned, has its differences. When bitten by non-venomous animals, there is a high risk of contracting rabies. On early stage the disease is suppressed by anti-rabies serum. Such wounds in most cases become purulent, so they try to delay PSO. When performing the procedure, a primary delayed suture is applied and antiseptic medications are used.

A wound caused by a snake bite requires the application of a tight tourniquet or bandage. In addition, the wound is frozen with novocaine or cold is applied. Anti-snake serum is injected to neutralize the venom. Spider bites are blocked with potassium permanganate. Before this, the poison is squeezed out and the wound is treated with an antiseptic.

Complications

Failure to thoroughly treat the wound with antiseptics leads to suppuration of the wound. The use of the wrong pain reliever, as well as the infliction of additional injuries, causes anxiety in the patient due to the presence of pain.

Rough treatment of tissues and poor knowledge of anatomy lead to damage large vessels, internal organs and nerve endings. Insufficient hemostasis causes the appearance of inflammatory processes.

It is very important that the primary surgical treatment of the wound is carried out by a specialist in accordance with all the rules.

Primary surgical treatment, or PST, of a wound is mandatory event during treatment open wounds of various nature. The health and sometimes the life of the injured person often depends on how this procedure is carried out. A correctly drawn up algorithm of a doctor’s actions is the key to successful treatment.

Damage human body can have varied look and the nature of its occurrence, but the basic principle of PCP of a wound remains unchanged - to ensure safe conditions to eliminate the consequences of injury through minor surgical procedures and disinfection of the affected area. The drugs and instruments may change, but the essence of the PCO does not change.

Features of open wounds

IN general case are called wounds mechanical damage body tissues with a violation of the integrity of the skin, in which gaping occurs and which are accompanied by bleeding and pain. According to the degree of damage, only soft tissue damage is distinguished; tissue damage, accompanied by damage to bones, blood vessels, joints, ligaments, nerve fibers; penetrating injuries - with damage to internal organs. Pathologies with a small and large affected area differ in extent.

According to the mechanism of appearance, wounds can be cut, punctured, chopped, torn, crushed, bitten, gunshot; according to the form of manifestation - linear, perforated, star-shaped, patchwork. If, as a result of injury, significant skin flaps are detached, then such destruction is usually called scalped. In the presence of gunshot injuries a through wound is possible.

All open lesions are initially considered infected, since the likelihood of pathogens entering and developing in them is very high. Moreover, failure to take action within 8-10 hours can lead to sepsis. The entry of soil into the site of injury gives rise to the development of tetanus. Any open lesion is accompanied by damage to blood vessels and nerve fibers, which causes profuse bleeding and pain syndrome. Many types of destruction (torn, crushed) cause necrosis of border tissues. Non-viable tissue cells appear in any affected areas if measures are not taken in the first hours after injury.

Principle of primary treatment

The first stage of treatment is to stop bleeding, eliminate pain syndrome, disinfection and preparation for suturing. The most important issue is sterilization of the affected area and removal of non-viable cells. If the injuries are not extensive and penetrating, and measures are taken in a timely manner, then disinfection can be carried out by ensuring the wound is cleaned. Otherwise, methods of primary surgical preparation (PSP of the wound) are used.

What is a wound toilet?

The principles of wound care are based on treating the affected area with an antiseptic drug while ensuring increased hygiene requirements. Small and fresh wounds do not have dead tissue around the injury, so sterilization of the area and surrounding area will be sufficient. Algorithm for toileting a purulent wound:

Getting ready Consumables: napkins, sterile cotton balls, medical gloves, antiseptic compounds (3% hydrogen peroxide solution, 0.5% potassium permanganate solution, ethanol), necrolytic ointments (“Levomekol” or “Levosin”), 10% sodium chloride solution.
The previously applied bandage is removed.
The area around the lesion is treated with a solution of hydrogen peroxide.
The state of the pathology and possible complicating factors are studied.
The skin around the injury is cleaned using sterile balls, moving from the edge of the injury to the side, treated with an antiseptic.
The wound is cleaned - removal of purulent composition, wiping with an antiseptic.
The wound is drained.
A bandage with a necrolytic drug (ointment) is applied and fixed.

The essence of PCP wounds

Primary surgical treatment is surgical procedure, including dissection of the marginal tissue in the damaged area, removal of dead tissue by excision, removal of all foreign bodies, installation of cavity drainage (if necessary).

Thus, along with medicinal treatment, mechanical antiseptics are used, and the removal of dead cells accelerates the process of regeneration of new tissues.

The procedure begins with incision of the lesion. The skin and tissue around the destruction are dissected with a cut up to 10 mm wide in the longitudinal direction (along the vessels and nerve fibers) to a length that allows visual examination of the presence of dead tissue and stagnant zones (pockets). Then, by making an arcuate incision, the fascia and aponeurosis are dissected.

Remnants of clothing are removed from the widened wound, foreign bodies, blood clots; By excision, crushed, contaminated and blood-soaked non-viable areas of tissue are removed. Lifeless areas of muscles (dark red), blood vessels and tendons are also eliminated. Healthy vessels and the fibers are stitched together. Using pliers, the sharp spike-shaped edges of the bone are bitten out (for fractures). After complete cleaning the primary suture is applied. When treating through-and-through gunshot wounds, PSO is performed separately from both the entrance and exit sides.

PSO of facial wounds. Injuries to the jaw area are the most common of facial wounds. PCS of such wounds has a certain algorithm of actions. First, medication is given antiseptic treatment skin on the face and oral cavity.

A solution of hydrogen peroxide is applied around the damage, a solution ammonia, iodine-gasoline. Next, the wound cavity is thoroughly washed with an antiseptic. Skin covering The face is carefully shaved and disinfected again. The victim is given an analgesic.

After preliminary procedures PST of facial wounds is performed directly according to an individual plan, but with the following sequence of manipulations: treatment of the bone area; treatment of soft adjacent tissues; fixation of splinters and fragments of the jaw; suturing in the sublingual area, oral vestibule and in the tongue area; wound drainage; placing the primary suture on soft fabrics wounds. The procedure is carried out under general anesthesia or under local anesthesia depending on the severity of the damage.

Algorithm for PCS of bite wounds. Enough a common occurrence, especially among children, there are wounds resulting from pet bites. The PHO algorithm in this case is as follows:

Providing first medical care.
Rinsing the damaged area with a stream of water laundry soap V copious amounts For complete removal animal saliva.
Injection around the wound with a solution of lincomycin with novocaine; injection of drugs for rabies and tetanus.
Treatment of damage boundaries with iodine solution.
Carrying out PSO by excision of damaged tissue and cleaning the wound; the primary suture is applied only in the case of a bite from a vaccinated animal, if this fact has actually been established; If in doubt, a temporary bandage is applied with mandatory drainage.

Primary surgical treatment of wounds is effective way treatment open damage of any complexity.

Human skin has a colossal reserve of self-healing ability, and additional excision for the purpose of thoroughly cleaning the wound will not harm the healing process, and the removal of non-viable tissue will speed up the process of regeneration of new skin tissue.

Primary surgical treatment of the wound — surgery, aimed at removing non-viable tissue, preventing complications and creating favorable conditions for wound healing.

Prevention of the development of complications is achieved by a sufficiently wide dissection of the entrance and exit openings, removal of the contents of the wound channel and clearly non-viable tissues that make up the zone of primary necrosis, as well as tissues with questionable viability from the zone of secondary necrosis, good hemostasis, and complete drainage of the wound. Creating favorable conditions for wound healing comes down to creating conditions for regression pathological phenomena in the zone of secondary necrosis by influencing the general and local parts of the wound process.

Primary surgical treatment of the wound, if indicated, is performed in all cases, regardless of the timing of the wounded person’s admission. In military field conditions, primary surgical treatment of a wound may be forced to be postponed if there are no urgent and urgent indications. In such situations, paravulnar and parenteral (preferably intravenous) administration of antibiotics is used to prevent the development of purulent-infectious complications.

Depending on the timing of the procedure, primary surgical treatment is called early, if performed on the first day after injury; delayed, if performed during the second day; late, if performed on the third day or later.

Primary surgical treatment of the wound should ideally be comprehensive and immediate. This principle can be optimally implemented when providing early specialized surgical care. Therefore, at the stages of evacuation, where qualified surgical care is provided, primary surgical treatment of wounds of the skull and brain is not performed, and primary surgical treatment of gunshot bone fractures is performed only in cases of damage to the great vessels, infection of wounds with agents, radioactive substances, soil contamination and in case of extensive injuries to soft tissues. fabrics.

Primary surgical treatment of a gunshot wound as a surgical intervention includes six stages.

The first stage is wound dissection(Fig. 1) - made with a scalpel through the entrance (exit) opening of the wound canal in the form of a linear incision of sufficient length for subsequent work on the damaged area. The direction of the incision corresponds to topographic and anatomical principles (along the vessels, nerves, Langer's skin lines, etc.). The skin, subcutaneous tissue and fascia are dissected in layers. On the extremities, the fascia is dissected (Fig. 2) and beyond surgical wound throughout the entire segment in the proximal and remaining directions in a Z-shape for decompression of the fascial sheaths (wide fasciotomy). Focusing on the direction of the wound channel, the muscles are dissected along the course of their fibers. In cases where the extent of muscle damage exceeds the length of the skin incision, the latter expands to the boundaries of the damaged muscle tissue.

Rice. 1. Method of primary surgical treatment of a gunshot wound: wound dissection

Rice. 2. Method of primary surgical treatment of a gunshot wound: wide fasciotomy

Second stage - removal foreign bodies: wounding projectiles or their elements, secondary fragments, scraps of clothing, loose bone fragments, as well as blood clots, pieces of dead tissue that make up the contents of the wound channel. To do this, it is effective to wash the wound with antiseptic solutions using a pulsating stream. Some foreign bodies are located deep in the tissues and their removal requires special accesses and methods, the use of which is possible only at the stage of providing specialized care.

The third stage is excision of non-viable tissue(Fig. 3), that is, excision of the zone of primary necrosis and formed areas of secondary necrosis (where tissues have questionable viability). The criteria for preserved tissue viability are: bright color, good bleeding, for muscles - contractility in response to irritation with tweezers.

Rice. 3. Method of primary surgical treatment of a gunshot wound: excision of non-viable tissue

Excision of non-viable tissue is carried out layer by layer, taking into account the different tissue reactions to damage. The skin is the most resistant to damage, so it is excised sparingly with a scalpel. You should avoid cutting out large round holes (“nickels”) around the inlet (outlet) of the wound canal. Subcutaneous tissue is less resistant to damage and therefore is excised with scissors until there are clear signs of viability. The fascia has a poor blood supply, but is resistant to damage, so only those parts of it that have lost connection with the underlying tissues are excised. Muscles are the tissue where the wound process fully develops and in which secondary necrosis progresses or regresses. Scissors are methodically removed clearly non-viable mice: brown in color, do not contract, do not bleed when removed surface layers . Upon reaching the zone of viable muscles, hemostasis is carried out parallel to the excision.

It should be remembered that the zone of viable mice has a mosaic character. Areas of muscle where viable tissue clearly predominates, although there are minor hemorrhages, foci of reduced viability are not removed. These tissues constitute the zone of “molecular shock” and the formation of secondary necrosis. It is the nature of the operation and subsequent treatment that determines the course of the wound process in this area: progression or regression of secondary necrosis.

The fourth stage is surgery on damaged organs and tissues: skull and brain, spine and spinal cord, on the organs of the chest and abdomen, on the bones and pelvic organs, on main vessels, bones, peripheral nerves, tendons, etc.

Fifth stage - wound drainage(Fig. 4) - creating optimal conditions for the outflow of wound fluid. Drainage of the wound is carried out by installing tubes into the wound formed after surgical treatment and removing them through counter-apertures in the places lowest located in relation to the damaged area. With a complex wound channel, each pocket must be drained with a separate tube.

Rice. 4. Method of primary surgical treatment of a gunshot wound: drainage of the wound

There are three options for draining a gunshot wound. The simplest is passive drainage through a thick single-lumen tube(s). More complex - passive drainage through a double-lumen tube: The small channel carries out constant drip irrigation of the tube, which ensures its constant functioning. Both of these methods are used in the treatment of unsutured wounds and are the method of choice at the stages of providing qualified surgical care.

The third method is inflow and outflow drainage- used for tightly sutured wounds, that is, at the stage of providing specialized surgical care. The essence of the method is to install an input polyvinyl chloride tube of a smaller diameter (5-6 mm) and an output (one or several) silicone or polyvinyl chloride tube of a larger diameter (10 mm) into the wound. In the wound, the tubes are installed in such a way that the liquid washes the wound cavity through the inlet tube and flows freely through the outlet tube. Best effect is achieved with active flow and ebb drainage, when the outlet tube is connected to the aspirator and a weak negative pressure of 30-50 cm of water column is felt in it.

The sixth stage is wound closure. Taking into account the characteristics of a gunshot wound (presence of a zone of secondary necrosis) The primary suture is not applied after initial surgical treatment of a gunshot wound.

The exception is superficial wounds scalp, wounds of the scrotum, penis. Chest wounds with open pneumothorax when the chest wall defect is small, there is little damaged tissue and there are conditions for closure of the defect without tension after complete primary surgical treatment of the wound; otherwise, preference should be given to ointment dressings. During laparotomy, from the side abdominal cavity After processing the edges, the peritoneum in the area of the entrance and exit openings of the wound canal is tightly sutured, and the wounds of the entrance and exit openings themselves are not sutured. The primary suture is also applied to surgical wounds located outside the wound canal and formed after additional access to the wound canal - laparotomy, thoracotomy, cystostomy of access to the great vessels along the length, to large foreign bodies, etc.

After initial surgical treatment, one or several large gaping wounds are formed, which must be filled with materials that have drainage function in addition to the installed drainage pipes. The most in a simple way is the introduction into the wound of gauze napkins moistened antiseptic solutions or water-soluble ointments in the form of “wicks”. More effective method- this is filling the wound with carbon sorbents, accelerating the process of wound cleansing (used at the stage of providing specialized medical care). Since any dressing in a wound loses its hygroscopicity and dries out after 6-8 hours, and dressings at such intervals are impossible, graduates must be installed in the wound along with napkins - polyvinyl chloride or silicone “half-tubes”, i.e. tubes with a diameter of 10-12 mm , cut lengthwise into two halves.

With absence infectious complications after 2~3 days the wound is sutured delayed primary suture.

After the initial surgical treatment, as after any surgical intervention, a protective-adaptive system develops in the wound. inflammatory reaction, manifested by plethora, edema, exudation. However, since tissues with reduced viability can be left in a gunshot wound, inflammatory edema, disrupting blood circulation in the altered tissues, contributes to the progression of secondary necrosis. In such conditions the effect on the wound process is to suppress the inflammatory response.

For this purpose, immediately after the initial surgical treatment of the wound and during the first dressing, an anti-inflammatory blockade is performed (according to I. I. Deryabin - A. S. Rozhkov) by introducing a solution of the following composition into the circumference of the wound (calculation of ingredients is carried out per 100 ml of novocaine solution, and the total volume of the solution is determined by the size and nature of the wound) 0.25% novocaine solution 100 ml glucocorticoids (90 mg prednisolone), protease inhibitors (130,000 ED kontrikala) antibiotic wide range action - aminoglycoside, cephalosporin or their combination in a double single dose. Indications for repeated blockades are determined by the severity of the inflammatory process.

Repeated surgical treatment of the wound (according to primary indications) performed when the dressing detects progression of secondary necrosis in the wound (in the absence of signs of wound infection). The purpose of the operation is to remove necrosis of the diatomaceous tissue and eliminate the cause of its development. In case of violation main blood flow large muscle masses are necrotic, muscle groups - in cases of necrotomy are extensive, but measures must be taken to restore or improve the main blood flow. The cause of the development of secondary necrosis is often errors in the technique of the previous intervention (inadequate dissection and excision of the wound, failure to perform fasciotomy, poor hemostasis and drainage of the wound, application of a primary suture, etc.).

Gumanenko E.K.

Military field surgery

1. Toilet the wound (washing away blood and dirt, freeing foreign bodies)

2. Dissection of the wound (corresponds to surgical access). For subsequent full revision, the incision must be adequate in size. It is advisable to perform the dissection along Langer's lines so that the gap can be eliminated by applying sutures without tissue tension.

3. Excision of the edges, walls and bottom of the wound. In this case, mechanical removal of microbes, foreign bodies and necrotic tissues occurs within healthy tissues. The skin, subcutaneous tissue, aponeuroses, and muscles are subject to excision. Nerves, blood vessels, and internal organs are not excised. The thickness of the excised tissue is usually 0.5-1 cm. On the face, hands and feet, excision should be more economical due to tissue deficiency, up to complete absence excision at cut wounds(good blood supply to the face and hands makes uncomplicated healing possible).

4. Revision of the wound channel. The inspection should only be visual, since palpation or instrumental inspection does not give a complete picture of the nature of the damage to tissues and organs.

5. Hemostasis in relation to bleeding caused by a traumatic agent and to intraoperative bleeding.

6. Restoration of anatomical relationships. Sutures are applied to organs, fascia, aponeuroses, nerves, tendons, etc.

7. Rational drainage. Indicated when performing PHO in late dates(more than 24 hours), with extensive damage, unreliable hemostasis, crossing a significant number of lymphatic drainage paths.

8. Applying a suture to the skin.

Types of wound closure

1. Self-epithelialization

2. Primary suture - applied to PSO operations of the wound

3. Primary delayed suture - applied to infected wound before granulation develops in the wound (up to 5 days)

4. Forced-early secondary suture - applied to purulent wound with successful use of methods of active influence on the wound process for 3-5 days.

5. Early secondary suture - applied to a cleaned granulating wound (6-21 days)

6. Late secondary suture - applied after 21 days from the wound after excision of granulations and scar, which worsen the blood supply to the edges of the wound during this period).

7. Skin grafting.

Types of Pho

1. Early (in the first 24 hours) is performed in the absence of inflammation and ends with the application of a primary suture.

2. Delayed (24-48 hours) is performed in conditions of inflammation; when applying a primary suture, it must be completed with drainage. It is also possible that the wound is not sutured during surgery, and then in the first 5 days, in the absence of progression of inflammation, a primary delayed suture is applied.

3. Late (48-72 hours) is performed in conditions of severe inflammation with significant tissue swelling. The wound is left open, then secondary sutures are applied, skin grafting is performed, or the wound is left open until independent epithelialization is completed.

Postoperative treatment of a former infected wound is carried out according to the principles of treatment of aseptic wounds (see points 2-5). In addition, in case of accidental injuries, tetanus prophylaxis must be carried out (1 ml of tetanus toxoid and 3000 IU antitetanus serum subcutaneously in different syringes in different areas body).

If suppuration of a postoperative wound occurs, treatment is carried out according to the principles of treating purulent wounds.

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Primary surgical treatment of a wound in medicine is a specific surgical intervention, the purpose of which is to remove from the wound cavity various foreign bodies, debris, dirt, areas of dead tissue, blood clots and other elements that can lead to complications during the treatment process and increase recovery time and restoration of damaged tissues.

In this article you will learn the types and algorithm for performing primary surgical treatment of a wound, as well as the principles of PSO, features and types of sutures.

Types of primary wound treatment

Primary surgical treatment of wounds, if there are indications for such a procedure, is carried out in any case, regardless of when the victim was admitted to the department. If for some reason it was not possible to carry out treatment immediately after receiving a wound, then the patient is administered antibiotics, preferably intravenously.

Primary surgical treatment of the wound depending onThe timing of the procedure is divided into:

Certainly, ideal option There is a situation when PST of a wound is carried out simultaneously immediately after injury and at the same time is an exhaustive treatment, but this is not always possible.

Types and features of seams

Sutures may be applied during wound treatment different ways, and each type has its own characteristics:

How is PHO carried out?

Primary wound treatment is carried out in several main stages. Algorithm for PCP of a wound:

The first step is dissection of the wound cavity with a linear incision. The length of such an incision should be sufficient for the doctor to carry out all work on the injury. The incision is made taking into account the topographic and anatomical features of the structure of the human body, that is, in the direction along the nerve fibers, blood vessels, as well as Langer’s skin lines. Layers of skin and tissue, fascia and subcutaneous tissue cut in layers so that the doctor can accurately determine the depth of the damage. Muscle dissection is always carried out along the fibers.
The second stage of treatment can be considered the removal of foreign bodies from the wound cavity. When gunshot wounds such an object is a bullet, with fragmentation - shell fragments, with knife and cut - a cutting object. In addition, when any injury occurs, various small items, garbage that also needs to be removed. At the same time as removing all kinds of foreign bodies, doctors also remove dead tissue, formed blood clots, particles of clothing, and bone fragments, if any. The entire contents of the existing wound channel are also removed, for which the method of washing the wound with a special apparatus with a pulsating stream of solution is usually used.
At the third stage, tissue that has lost viability is excised.. In this case, the entire area of primary necrosis is removed, as well as areas of secondary type necrosis, that is, those tissues whose viability is in doubt. Typically, the doctor evaluates the tissue according to certain criteria. Viable tissue is characterized by bright color and bleeding. Living muscles should respond by contracting fibers when irritated with tweezers.

Secondary debridement

Carrying out secondary treatment (secondary treatment) is required in cases where a purulent focus and serious inflammation forms in the wound. In this case, the released ichor does not come off on its own, and purulent streaks and areas of necrosis begin to appear in the wound.

When carrying out secondary treatment, the first step is to remove accumulations from the wound cavity. purulent exudate, and then, hematomas and blood clots. After this, the surface of the damaged area and surrounding skin is cleaned.

WMO is carried out in several stages:

Tissues that have no signs of viability are excised.
Blood clots, hematomas and other elements, as well as foreign bodies, if present, are removed.
The wound pockets and resulting leaks are opened in order to clean them.
Secondary cleaned wounds are drained.

The difference between primary and secondary treatment is that primary treatment is carried out upon receipt of any wound, as well as during operations.

Secondary treatment is carried out only in cases where the primary treatment was not enough and a purulent-inflammatory process began in the wound. In this case secondary processing wound is necessary to prevent the development of serious complications.