3. What is a wound?
⚫ It is a circumscribed injury which is caused by an external
force and it can involve any tissue or organ.
surgical, traumatic
It can be mild, severe, or even lethal.
Simple wound
Compound wound
Acute
Chronic
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4. Parts of the wound
Wound edge Wound
corner
Surface of
the wound
Base of the wound
Cross section of a simple wound
Skin surface
Subcutaneus tissue
Superficial fascia
Muscle layer
Base of the wound
Wound edge
Surface of
the wound
Wound
cavity
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5. The ABCDE in the injured assessment
The mnemonic ABCDE is used to remember the order
of assessment with the purpose to treat first that kills
first.
⚫ A: Airway and C-spine stabilization
⚫ B: Breathing
⚫ C: Circulation
⚫ D: Disability
⚫ E: Environment and Exposure
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6. Wound management
⚫When and where was the wound occured?
⚫Alcohol and drug consumption
⚫What did caused the wound?
⚫The circumstances of the injury
⚫Other diseases eg. diabetes mellitus, tumour,
atherosclesosis, allergy
⚫The state of patient’s vaccination against Tetanus
⚫Prevention of rabies
⚫The applied first-aid
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7. Classification of the accidental wounds
1. Based on the origin
⚫ 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
⚫ III. Wounds caused by radiation
⚫ IV. Wounds caused by thermal forces:
⚪ 1. Burning
⚪ 2. Freezing
⚫ V. Special
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8. 1.) Abraded wound
(v. abrasum)
2.) Punctured wound
(v. punctum)
⚫ Superficial part of the epidermal
layer
⚫ Good wound healing
⚫ Sharp-pointed object
⚫ Seems negligible
BUT
⚫ Anaerobic infection
⚫ Injury of big vessels and nerves
Mechanical wounds
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14. 1.) Acid 2.) Base
⚫ in small concentration – irritate
⚫ in large concentration –
coagulation necrosis
⚫ colliquative necrosis
Chemical wounds
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15. Symptoms and severity
depend on:
⚫ Amount of radiation
⚫ Length of exposure
⚫ Body part that was exposed
Symptoms may occur immediately,
after a few days, or even as long
as months.
What part of the body is
most sensitive during
radiation sickness?
bone marrow
gastrointestinal tract
Wounds caused by radiation
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16. 1.) Burning 2.) Freezing
⚫ 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
Wounds caused by thermal forces
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Metabolic change! - toxemia ⚫ mild, moderate, severe (redness,
bullas, necrosis)
⚫ rewarm – not only the frozen area
but the whole body
18. Classification of the wounds
2. According to the bacterial contamination
⚫Clean wound
⚫Clean-contaminated wound
⚫Contaminated wound
⚫Heavily contaminated wound
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19. ⚫Superficial
⚫Partial thickness
⚫Full thickness
⚫Deep wound
Classification of the wounds
2. Depending on the depth of injury
+ bone, opened cavities, organs…etc.
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source: http://www.funscrape.com/Search/1/skin+layers.html
20. Wound management - history
⚫ Ancient Egypt – lint (fibrous base-wound site closure), animal grease
(barrier) and honey (antibiotic)
„closing the wound preserved the soul”
⚫ Greeks – acute wound= „fresh” wound; chronic wound = „non-healing”
wound
maintaining wound-site moisture
⚫ Ambroise Paré – hot oil ↔ oil of roses and turpentine, ligature of
arteries instead of cauterization
⚫ Lister pretreated surgical gauze – Robert Wood Johnson →1870s;
gauze and wound dressings treated with iodide
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32. Complications of wound healing
I. Early complications
⚫Seroma
⚫Hematoma
⚫Wound disruptin
⚫Superficial wound infection
⚫Deep wound infection
⚫Mixed wound infection
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33. 1.) Seroma 2.) Hematoma
⚫ Filled with serous fluid, lymph
or blood
⚫ Fluctuation, swelling, redness,
tenderness, subfebrility
TREATMENT:
⚫ Sterile punture and
compression
⚫ Suction drain
Early complications of wound healing
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⚫ Bleeding, short drainage time,
anticoagulant
⚫ Risk of infection
⚫ Swelling, fluctuation, pain,
redness
TREATMENT
⚫ Sterile puncture
⚫ Surgical exploration
34. 3.) Wound disruption
A. partial – dehiscenece
B. complete - disruption
⚫ Surgical error
⚫ Increased intraabdominal
pressure
⚫ Wound infection
⚫ Hypoproteinaemia
TREATMENT:
⚫ U-shaped sutures
Early complications of wound healing
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35. 1.) Diffuse 2.) Localized
⚫ Located below the skin
TREATMENT
⚫ Resting position
⚫ Antibiotic
⚫ Dermatological consultation
⚫ Anywhere
TREATMENT
⚫ Surgical exploration
⚫ Drainage
⚫ X-ray examination
Early complications of wound healing
Superficial wound infection
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e.g. erysipelas e.g. abscess
36. 1.) Diffuse 2.) Localized
TREATMENT
⚫Surgical exploration
⚫Open therapy
⚫H2O2 and antibiotics
e.g. anaerobic necrosis
⚫ Inside the tissues or body cavities
TREATMENT
⚫ surgical exploration
⚫ drainage
Early complications of wound healing
Deep wound infection
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37. Mixed wound infection
e.g. gangrene
⚫ necrotic tissues
⚫ putrid and anaerobic
infection
⚫ a severe clinical picture
TREATMENT
⚫ aggresive surgical
debridement
⚫ effective and specified
(antibiotic) therapy
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Complications of wound healing
I. Early complications
38. Complications of wound healing
II. Late complications
⚫Hyperthrophic scar
⚫Keloid formation
⚫Necrosis
⚫Inflammatory infiltration
⚫Abscesses
⚫Foreign body containing abscesses
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39. Hypertrophic scar Keloid
⚫ Develop in areas of thick
chorium
⚫ Non-hyalinic collagen
fibres and fibroblasts
⚫ Confine to the incision
line
TREATMENT
⚫ Regress spontaneously
(1-2 yrs)
Late complications
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⚫ 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
41. Anatomical Diffuse
⚪ Arterial – bright red,
pulsate
⚪ Venous – dark red,
continuous
⚪ Capillary – can become
serious
⚪ Parenchymal
Bleeding
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42. Bleeding
Severity of bleeding – the volume of the lost blood and
time
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source: http://lifeinthefastlane.com/2012/03/trauma-tribulation-025/
43. The direction of hemorrage
⚫External
⚫Internal
⚪ In a luminar organ (hematuria, hemoptoe, melena)
⚪ In body cavities (intracranial, hemothorax, hemascos,
hemopericardium, hemarthros)
⚪ Among the tissues (hematoma, suffusion)
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44. Bleeding
⚫ 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
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45. Local General
⚫ Hematoma, suffusion,
ecchymosis
⚫ Compression in the pleural
cavity, in pericardium, in the
skull
⚫ Functional disturbancies – e.g.
hyperperistalsis
⚫ Pale skin, cyanosis, decreased
BP. and tachycardia, difficulty
in breeding, sweeting,
decreased body temperature,
unconsciousness, cardiac and
laboratory standstill, laboratory
disorders, signs of shock
Signs of the bleeding
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46. Surgical hemostasis
Aim – to prevent the flow of blood from the incised or
transected vessels
⚫Mechanical methods
⚫Thermal methods
⚫Chemical and biological methods
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48. Thermal methods
⚫Low temperature
⚪ Hypothermia – eg. stomach bleeding
⚪ Cryosurgery
⯍ dehidratation and denaturation of fatty tissue
⯍ decreases the cell metabolism
⯍ vasoconstriction
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49. Thermal methods
⚫High temperature
⚪ Electrosurgery – electrocauterization
⚪ Monopolar diathermy
⚪ Bipolar diathermy
⚪ Laser surgery
coagulation and vaporization
for fine tissues
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