Wounds –types&managment

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Wounds –types&managment

  1. 1. TYPES OF WOUNDS COLLEGE OF DENTISTRY 2012-2013 GENERAL SURGERY
  2. 2. WOUNDS –TYPES&MANAGMENTSIMPLY IT IS DISCONTINUITY OF EPITHELIAL SURFACE.TYPES;GENERAL CLASSIFICATION;TIDY AND UNTIDY:TIDY: SHARP CLEAR CUT CLOSED PRIMARLY.UNTIDY:CRUSHING,TEARING,WITH DEVITALISED TISS-UE.THIS NEEDS TO DO WOUND EXCISION TO MAKE ITTIDY AND SO CLOSE IT EITHER PRIMARLY(PRIMARYCLOSURE),OR DELAYED PRIMARY OR EVEN SECOND-ARY CLOSURE OR SUTURE.
  3. 3. TIDY & UNTIDY TYPES UNTIDY WOUND—SUTURING AFTERTIDY WOUND – PRIMARY SUTURING EXCISION&CLEANING
  4. 4. OTHER CLASSIFICATION OF TYPES OF WOUNDSCLOSED & OPENED.CLOSED WOUNDS: CONTUSION AND HAEMATOMA.BLUNT TRAUMA,NO, SKIN CUT.OPENED WOUNDS:ABRASION:SCRAPING OF SUPERFICIAL SKIN LAYERDUE TO FRICTION.
  5. 5. CLOSED WOUNDSCONTUSION -- HAEMATOMA BLUNT TRAUMA—SKIN INTACT
  6. 6. OPEN WOUND--ABRASIONSUPERFICIAL SKIN SCRAPING DUE TO FRICTION
  7. 7. OPEN WOUNDS..CONT,D--INCISED WOUND :CLEAR,CLEAN CUT e.g.SURGICAL WOUNDS,RAZOR CUT OR CUT WITH KNIVES.--LACERATED WOUND:IRRIGULAR SHAPED WOUDND USUALLY CONTAMINATED,COMMONLY SEEN IN R.T.A.,FALL FROM A HEIGHT,AND BLUNT TRAUMA.--CRUSHING WOUND: IT IS SKIN DEGLOVING,&DEVI- TALISED TISSUE WITH CLOSED FASCIAL COMPARTM- ENT SYNDROME ,WHICH NEEDS URGENT FASCIOT OMY.---PENETRATING WOUND:STAB WOUND LIKE KNIFE STAB.
  8. 8. INCISED WOUNDS
  9. 9. LACERATED WOUND-IRRIGULAR EDGE
  10. 10. CRUSHING WOUNDSWITH OR WITHOUT FRACTURE BONES DEGLOVING SKIN AND MUSCLE CRASH
  11. 11. PENETRATING WOUND
  12. 12. BITE WOUND--CONTAMINATED HUMAN BITE ANIMAL BITE
  13. 13. OPENED WOUNDS—CONT,DBITES:ANIMAL & HUMAN WITH HIGH INCIDENCE OF INFECTION.MISSILE INJURY WOUNDS:2 TYPES OF MISSILES: LOW VELOCITY LIKEPISTOL;CAUSING DAMAGE ALONG THE TRACK THR-OUGH IT THE BULLET PASSED.HIGH VELOCITY MISSILE: DAMAGE A LONG THE TRACKAND AWAY FROM THE TRACK DUE TO THE SHOCKWAVE CAVITATIONAL EFFECT LIKE BONE FRAGMENTA-TION OR LIVER SHATTERING WHEN THE MISSILE PASSESBESIDE THEM ,AND NOT NECESSARY THROUGH THEM.
  14. 14. PISTOL MISSILE—LOW VELOCITY
  15. 15. HIGH VELOCITY MISSILELOW & HIGH VELOCITY MISSILE HIGH VELOCITY MISSILE
  16. 16. MANAGEMENT OF WOUNDS---FIRST ABCDE RESUSSCITATION.INCLUDINGPRESSURE ON THE BLEEDING WOUND.---TAKE HISTORY ; WHEN WAS THE ACCIDENT ?---PROPHYLAXIS AGINST TETANUS.---ANTIBIOTICS ;PARTICULARLY LACERATED WOUND EVEN GIVE ANTIBIOTIC AGAINST ANAEROBIC INFEC- TION.---TAKE PATIENT TO THE THEATRE. CLEAN THE WOUND PROPERLY WITH NORMAL SALINE ,ADD SOME ANTISEPTIC LIKE POVIDONE IODINE (BETADINE) .
  17. 17. WOUND MANAGEMENT---CONT,D---INSPECT THE WOUND: CLEAN INCISED OF LESS THAN 6 HOURS DO PRIMARYSUTURING OR CLOSURE.ANY NERVE OR TENDON CUT,DOSUTURING. IF CONTAMINATED DIRTY,CLEAN & WASH,DO N,T CLOSE THE WOUND BUT LEAVE IT OPENED FOR 4-6 DAYS AND THEN DO SUTURING SO CALLED DELAYED PRIMARY SUTURING.ALL LACERATED,CRUSHED ,BITES & MISSILES DO ,PROPER WOUND EXCISION AND DEBRIDEMENT INCLUDING ALLDEAD TISSUES AND DEBRIS ,AND DOFASCIOTOMY IF THE LIMB SWOLLEN & OEDEMATOUS ANDPAINFUL.THE WOUND SHOULD LEFT OPENED & CLOSE IT AFTER 4-6 DAYSOR EVEN AFTER 2 WEEKS (SECONDARY SUTURING).
  18. 18. TO SUTURE OR NOTIF YOU HAVE A WOUND WHICH YOU ARE IN SUSPICI-OUN,REGARDING CLEANLINESS OR CONTAMINATIONDO NOT SUTURE.WHEN TO REMOVE THE STICHES ?FACE , SCALP & NECK AFTER 5-7 DAYS AFTER SUTUR-ING ,BECAUSE OF GOOD BLOOD SUPPLY.ABDOMEN;AFTER 7-10 DAYS .UPPER LIMBS;AFTER 7-10 DAYS.BACK & LOWER LIMBS 10-15 DAYS.NOTE:DO N,T COUNT DAY OF SURGERY.
  19. 19. TYPES OF SURGICAL WOUNDS ACCORDING TO RATE OF INFECTIONCLEAN WOUND:HERNIA,THYROID,BREAST-INFECTIONRATE 1-2%.CLEAN CONTAMINATED:ORAL SURGERY,GASTRIC,SM-ALL BOWEL SURGERY,CHOLECYSTECTOMY-INFECTIONRATE LESS THAN 10% .CONTAMINATED WOUND: APPENDICECTOMY,RATE OF INFECTION 15-20 %.DIRTY WOUNDS:DRAINAGE OF ABSCESS,RATE OF INFECTION LESS THAN 40%
  20. 20. CHRONIC WOUNDSCHRONIC ULCER-VENOUS ULCER BED SORE,PRESSURE SORE,DECUBITUS ULCER

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