Professional Documents
Culture Documents
GYRGYI SZAB
ASSISTANT PROFESSOR
DEPARTMENT OF SURGICAL
RESEARCH AND TECHNIQUES
WOUND
What is a wound?
3
Wound edge
Wound
corner
Surface of
the wound
Base of the wound
Skin surface
Subcutaneus tissue
Superficial fascia
Muscle layer
atherosclesosis, allergy
The state of patients vaccination against Tetanus
Prevention of rabies
The applied first-aid
Mechanical wounds
8
Sharp-pointed object
layer
Good wound healing
Seems negligible
BUT
Anaerobic infection
Injury of big vessels and nerves
Mechanical wounds
9
Sharp object
Best healing
force
Edges - uneven
Mechanical wounds
10
Blunt force
Pressure injury
Edges uneven and torn
Bleeding
(v. lacerocontusum)
Mechanical wound
11
aperture
output
slot tunel
unijured tissue
necrobiotic zone
necrotic zone
foreign bodies
Mechanical wounds
12
Distal
Proximal
Chemical wounds
14
1.) Acid
coagulation necrosis
2.) Base
colliquative necrosis
bone marrow
gastrointestinal tract
1.) Burning
Metabolic change! - toxemia
a normal skin
1 - 1st degree superficial injury
(epidermis)
2 2nd degree partial or deep partial
thickness (epidermis+superficial or deep
dermis)
3 3rd degree full thickness (epidermis
+ entire dermis)
4 4th degree (skin + subcutaneous
tissue + muscle and bone)
Treatment:
Cooling cold water and clean covering
2.) Freezing
mild, moderate, severe (redness,
bullas, necrosis)
rewarm not only the frozen area
but the whole body
Special wounds
17
Clean wound
Clean-contaminated wound
Contaminated wound
Heavily contaminated wound
Superficial
Partial thickness
Full thickness
Deep wound
source: http://www.funscrape.com/Search/1/skin+layers.html
Ancient Egypt lint (fibrous base-wound site closure), animal grease (barrier)
black
black-yellow
yellow
yellow-red
red
red-pink
pink
contamination
sterility
critical colonisation
colonisation
infection
Viscosity
volume
high - 5
medium - 3 low - 1
high - 5
medium -3
low - 1
Surgical incision
Stretch and fix
Handling the scalpel
Langer lines
Skin edges
Vessels and nerves
Hemostasis
Langer lines
source: http://www.medars.it/galleries/langer.htm
Skin:
Stiches
Clips
Steri-Strips
Tissue glues
Fascia and subcutaneous layers:
Interrupted stiches
Fat fat necrosis!
Dressing: sterile, moist, antibiotic-containing, non-allergic,
non-adhesive
Hemostasis-inflammation
Granulation-proliferation
Remodelling
capillaries
fibroblasts
lymphocytes
macropha
ges
neutrophyl gr.
thromboc
ytes
0
1
2
3
4 5
10
11
10
13
14
15
http://www.worldwidewounds.com/2004/august/Enoch/images/enochfig1.jpg
1. Hemostasis-inflammation
vasoconstriction
fibrin clot formation
proinflammatory citokines and
growth factors releasing
vasodilatation
infiltration PMNs, macrophages
cytokines releasing
angiogensis
fibroblast activation
B- and T-cells activation
keratinocytes activation
wound contraction
2. Granulation-proliferation
fibroblast migration
collagen deposition
angiogensis
granulation tissue formation
epithelisation
contraction
3. Remodelling
regression of many capillaries
physical contraction myofibroblasts
collagen degeneration and synthetisation
new epithelium
tensile strength max. 80%
Healing by primary
intention
Healing by secondary
intention
Healing by tertiary
intention
source: http://quizlet.com/13665246/chapter-3-tissue-renewal-regenerationand-repair-flash-cards/
Local
Ischemia
Infection
Foreign body
Edema, elevated
tissue pressure
Hyperbaric oxygen
treatment
infectio
n
foreign
bodies
IMPAIRE
D
HEALING
edema/
elevated
tissue
pressure
ischem
ia
Seroma
Hematoma
Wound disruptin
Superficial wound infection
Deep wound infection
Mixed wound infection
1.) Seroma
2.) Hematoma
or blood
Fluctuation, swelling, redness,
tenderness, subfebrility
anticoagulant
Risk of infection
Swelling, fluctuation, pain,
redness
TREATMENT:
Sterile punture and
compression
Suction drain
TREATMENT
Sterile puncture
Surgical exploration
pressure
Wound infection
Hypoproteinaemia
TREATMENT:
U-shaped sutures
A. partial dehiscenece
B. complete - disruption
1.) Diffuse
2.) Localized
Anywhere
TREATMENT
Resting position
Antibiotic
Dermatological consultation
TREATMENT
Surgical exploration
Drainage
X-ray examination
e.g. erysipelas
e.g. abscess
1.) Diffuse
2.) Localized
TREATMENT
Surgical exploration
Open therapy
H2O2 and antibiotics
TREATMENT
surgical exploration
drainage
e.g. gangrene
necrotic tissues
putrid and anaerobic
infection
a severe clinical picture
TREATMENT
aggresive surgical
debridement
effective and specified
(antibiotic) therapy
Hyperthrophic scar
Keloid formation
Necrosis
Inflammatory infiltration
Abscesses
Foreign body containing abscesses
Late complications
39
Hypertrophic scar
Develop in areas of thick
chorium
Non-hyalinic collagen
fibres and fibroblasts
Confine to the incision
line
TREATMENT
Regress spontaneously
(1-2 yrs)
Keloid
Mostly African and Asian
population
Well-defined edge
Emerging, tough structure
Overproliferation of collagen
fibers in the subcutaneous tissue
Subjective complains
TREATMENT
Postoperative radiation
Corticosteroid + local anaesthetic
injection
40
Bleeding
41
Anatomical
Diffuse
Bleeding
42
source: http://lifeinthefastlane.com/2012/03/trauma-tribulation-025/
External
Internal
Bleeding
44
Preoperative hemorrhage
Prehospital care! maintenance of the airways, ventillation and circulation
bandages, direct pressure, turniquets
Intraoperative hemorrhage
anatomical and/or diffuse
depending on the surgeon, the surgery, position,
the size of the vessel, pressure in the vessel
ANESTHESIA!
Postoperative bleeding
ineffective local hemostasis, undetected hemostatic defect,
consumptive coagulopathy or fibrinolysis
Local
Hematoma, suffusion,
ecchymosis
Compression in the pleural
cavity, in pericardium, in the
skull
Functional disturbancies e.g.
hyperperistalsis
General
Pale skin, cyanosis, decreased
Surgical hemostasis
46
Mechanical methods
Thermal methods
Chemical and biological methods
Surgical hemostasis
Mechanical methods
47
Thermal methods
48
Low temperature
Thermal methods
49
High temperature
Electrosurgery electrocauterization
Monopolar diathermy
Bipolar diathermy
Laser surgery
coagulation and vaporization
for fine tissues
Thermal methods
50
High temperature
Electrocoagulation
Electrofulguration (A)
Electrodessication
Electrosection
vasoconstriction
coagulation
hygroscopic effect
Absorbable collagen
Absorbable gelatin
Microfibrillar collagen
Oxidized celluloze
Oxytocin
Epinephrine
Thrombin
Hemcon
QuikClot
HemCon