Professional Documents
Culture Documents
GYRGYI SZAB
ASSISTANT PROFESSOR
DEPARTMENT OF SURGICAL
RESEARCH AND TECHNIQUES
WOUND
What is a wound?
3
Simple wound
Compound wound
Acute
Chronic
Parts of the wound
4
Wound edge Wound
corner
Surface of
the wound
I. Mechanical:
1. Abraded wound (vulnus abrasum)
2. Puncured wound (v. punctum)
3. Incised wound (v. scissum)
4. Cut wound (v. caesum)
5. Crush wound (v. contusum)
6. Torn wound (v. lacerum)
7. Bite wound (v. morsum)
8. Shot wound (v. sclopetarium)
II. Chemical:
1. Acid
2. Base
V. Special
Mechanical wounds
8
(v. lacerocontusum)
Mechanical wound
11
aperture output
Ragged wound
Crushed tissue
Torn
Infection
Bone fracture
Prevention of rabies
Tetanus profilaxis
The direction of the flap
13
Distal Proximal
bone marrow
gastrointestinal tract
Wounds caused by thermal forces
16
Treatment:
Cooling cold water and clean covering
Special wounds
17
Clean wound
Clean-contaminated wound
Contaminated wound
Heavily contaminated wound
Classification of the wounds
2. Depending on the depth of injury
19
Superficial
Partial thickness
Full thickness
Deep wound
source: http://www.funscrape.com/Search/1/skin+layers.html
Wound management - history
20
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.med-
ars.it/galleries/langer.htm
Skin:
Stiches
Clips
Steri-Strips
Tissue glues
Fascia and subcutaneous layers:
Interrupted stiches
Fat fat necrosis!
Hemostasis-inflammation
Granulation-proliferation
Remodelling
capillaries
fibroblasts
lymphocytes
macrophages
neutrophyl gr.
thrombocytes
0 1 2 3 4 5 6 7 8 9 10 11 10 13 14 15
http://www.worldwidewounds.com/2004/august/Enoch/images/enochfig1.jpg
The main steps of the wound healing
29
1. Hemostasis-inflammation 2. Granulation-proliferation
vasoconstriction fibroblast migration
fibrin clot formation collagen deposition
angiogensis
proinflammatory citokines and granulation tissue formation
growth factors releasing epithelisation
contraction
vasodilatation 3. Remodelling
infiltration PMNs, macrophages regression of many capillaries
physical contraction myofibroblasts
collagen degeneration and synthetisation
cytokines releasing
new epithelium
angiogensis tensile strength max. 80%
fibroblast activation
B- and T-cells activation
keratinocytes activation
wound contraction
Types of wound healing
30
Healing by primary
intention
Healing by secondary
intention
Healing by tertiary
intention
source: http://quizlet.com/13665246/chapter-3-tissue-renewal-regeneration-
and-repair-flash-cards/
Factors affecting wound healing
31
Local Systemic
Ischemia Age and gender
Infection Sex hormones
Foreign body Stress
Edema, elevated Ischemia
tissue pressure Diseases
Obesity
Hyperbaric oxygen Medication
treatment Alcoholism and smoking
Immunocompromised
conditions
infection
Nutrition
foreign IMPAIRED
ischemia
bodies HEALING
edema/
elevated
tissue
pressure
Complications of wound healing
I. Early complications
32
Seroma
Hematoma
Wound disruptin
Superficial wound infection
Deep wound infection
Mixed wound infection
Early complications of wound healing
33
Surgical error
Increased intraabdominal
pressure
Wound infection
Hypoproteinaemia
TREATMENT:
U-shaped sutures
Early complications of wound healing
Superficial wound infection
35
TREATMENT TREATMENT
Resting position
Surgical exploration
Antibiotic
Drainage
Dermatological consultation
X-ray examination
e.g. gangrene
necrotic tissues
putrid and anaerobic
infection
a severe clinical picture
TREATMENT
aggresive surgical
debridement
effective and specified
(antibiotic) therapy
Complications of wound healing
II. Late complications
38
Hyperthrophic scar
Keloid formation
Necrosis
Inflammatory infiltration
Abscesses
Foreign body containing abscesses
Late complications
39
Anatomical Diffuse
source: http://lifeinthefastlane.com/2012/03/trauma-tribulation-025/
The direction of hemorrage
43
External
Internal
In a luminar organ (hematuria, hemoptoe, melena)
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
Signs of the bleeding
45
Local General
Mechanical methods
Thermal methods
Chemical and biological methods
Surgical hemostasis
Mechanical methods
47
Low temperature
Hypothermia eg. stomach bleeding
Cryosurgery
dehidratation and denaturation of fatty tissue
decreases the cell metabolism
vasoconstriction
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
Hemostasis with chemical and biological
methods
51
Absorbable collagen
Absorbable gelatin
Microfibrillar collagen
Oxidized celluloze
Oxytocin
Epinephrine
Thrombin
Hemcon
QuikClot
Hemostasis with chemical and biological
methods
52
HemCon