Bài giảng lớp y sỹ wound emergency

GYÖRGYI SZABÓASSISTANT PROFESSOR DEPARTMENT OF SURGICAL RESEARCH AND TECHNIQUES Classification and management of wound, principle of wound healing, haemorrhage and bleeding control Basic

GYÖRGYI SZABÓ

ASSISTANT PROFESSOR

DEPARTMENT OF SURGICAL RESEARCH AND TECHNIQUES

Classification and management of wound, principle of wound healing, haemorrhage and bleeding control

Basic Surgical Techniques, Faculty of Medicine, 3rd year

2021/13 Academic Year, Second Semester

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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.

Parts of the wound

cornerSurface of the woundBase of the wound

Cross section of a simple wound

Skin surfaceSubcutaneus tissueSuperficial fasciaMuscle layer

Base of the wound

Wound edge

Surface of

the wound

Woundcavity

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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

Wound management - anamnesis

 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,

Classification of the accidental wounds

1 Based on the origine

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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

5.) Crush wound

(v contusum)

6.) Torn wound (v lacerum)

7.) Shot wound (v scolperatium)

 Close - burn injury

 Foreign materials

Mechanical wound

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unijured tissue necrobiotic zone necrotic zone foreign bodies

aperture

slot tunel output

8.) Bite wound (v morsum)

Distal Proximal

The wound healing is good

The direction of the flap

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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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 3 – 3 rd degree – full thickness

(epidermis + entire dermis)

 4 – 4 th degree – (skin + subcutaneous

tissue + muscle and bone)

 Treatment:

 Cooling – cold water and clean covering

Wounds caused by thermal forces

Exotic, poisonous animals

Classification of the wounds

2 According to the bacterial contamination

 Superficial

 Partial thickness

 Full thickness

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

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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Applied wound management -

Applied wound management

the quantity and diversity of microbes

source: Applied wound management supplement – www.wounds-uk.com

Applied wound management

The wound managemanet

 clean, hemostasis, covering

 clean, anaesthesis, excision, sutures

 ALWAYS: thoracic cavity, abdominal wall or dura mater injury

 NEVER: war injury, inflammation, contamination, foreign

body, special jobs,

bite, shot, deep punctured wound

 clean, wash – saline, cover

 excision of wound edges, sutures

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The wound managemanet

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 after inflammation, necrosis – proliferation

 anesthesia, refresh wound edges, suturing and draining

 anesthesis, scar excision, suturing, draining

 greater defect – plastic surgery

The surgical wound

 Surgical incision

 Stretch and fix

 Handling the scalpel

 Langer lines

 Skin edges

 Vessels and nerves

The wound edges

Handling the scalpel

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source: ars.it/galleries/langer.htm

http://www.med-Tissue unifying and dressing the wound

Fat – fat necrosis!

Dressing: sterile, moist, antibiotic-containing, allergic, non-adhesive

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The wound healing

 Granulation-proliferation

capillaries fibroblasts

lymphocytes macrophages

The main steps of the wound healing

1 Hemostasis-inflammation

vasoconstriction

fibrin clot formation

proinflammatory citokines and

growth factors releasing

granulation tissue formation epithelisation

contraction

3 Remodelling

regression of many capillaries physical contraction – myofibroblasts collagen degeneration and synthetisation new epithelium

tensile strength – max 80%

Types of wound healing

http://quizlet.com/13665246/chapter-3-tissue-renewal-regeneration-Factors affecting wound healing

IMPAIRED HEALING

Complications of wound healing

I Early complications

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3.) Wound disruption A partial – dehiscenece

Early complications of wound healing

Superficial wound infection

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Early complications of wound healing

Deep wound infection

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Mixed wound infection

Complications of wound healing

II Late complications

Hypertrophic scar Keloid

 Develop in areas of

thick chorium

 Non-hyalinic collagen

fibres and fibroblasts

 Confine to the incision

 Subjective complains

TREATMENT

 Postoperative radiation

 Corticosteroid + local anaesthetic injection

BLEEDING AND HEMOSTASIS

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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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anatomical and/or diffuse

depending on the surgeon, the surgery, position,

the size of the vessel, pressure in the vessel

decreased body temperature, unconsciousness, cardiac and laboratory standstill, laboratory disorders, signs

of shock

Signs of the bleeding

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Surgical hemostasis Mechanical methods

 Digital pressure – direct pressure, e.g Pringle maneuver

Thermal methods

 Hypothermia – eg stomach bleeding

 Cryosurgery

 dehidratation and denaturation of fatty tissue

 decreases the cell metabolism

 vasoconstriction

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coagulation and vaporization

for fine tissues

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Hemostasis with chemical and biological

methods

vasoconstriction coagulation hygroscopic effect

Absorbable collagen

Absorbable gelatin

Hemostasis with chemical and biological

methods

HemCon

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