Modern Principles of Wound Classification and Treatment

1. Wounds. Classification. Description of wound process. Running sore. Modern principles of treatment. m.d. Shydlovscky. A.V.

2. WOUND – be what mechanical damage of organism, which is accompanied violation of integumentarycilouse tissues (skin, mucus shells). BASIC SIGNS OF WOUND PAIN – depends on wound localization, damage of nervous structures, character of injuring agent, nervous - psychological state of organism. BLEEDING – depends on the type of vessels and character of their injuring, localization of wound, state of local and general hemodynamics, state of the convolutional system of blood. GAPING – it is determined direction of wound in relation to the lines of Langera.

3. Factors which must be taken into account during classification of wounds • Genesis ( reasons of origin). • Degree of infecting. • Character of wound. • Attitude toward the cavities of body. • Motion of wound channel.

4. Classification of wounds by the character of wound • Cut - vulnus incisum • Shaking - vulnus punctum • Chopped - vulnus caesum • Chopped - vulnus contusum • Squashed - vulnus conguassatum • Poisonous - vulnus venenatum • Gun shout- vulnus sclopetarium • Mixed- vulnus mixtum • Bitten - vulnus morsum • Lacerated - vulnus lacerum

5. Types of injuries: 1. Incised wound. 2. Stab wound without damaging the bones. 3. Firearm wound with damage to the bones. 4. Torn-destructive wound. 5-8 of wound healing by secondary intention: 5. Laceration. 6. The wound is cleaned and turns granulation. 7. The wound is filled with granulation. 8. Scarring.

6. By degree of infecting : - aseptic, infected, purulent. For the running of wound channel : - blind, through, tangents. In relation to body cavities: - penetrable, nonpenetraiting. On complication : - simple, difficult. On the area of damage– anatomic area of body. Combined wounds.

7. Features of gunshot wounds • Area of primary wound channel, which is diagnosed clinically at once after a wound; • Area of primary traumatic necrosis, where a parabiosis and grow stiff penetrate as separate hearths, that clinically in the first clock after a wound, establishing hardness; • Area of molecular concussion, wherever parabiotic changes in general clinically are not established, but demonstrate, as a rule in future at the inadequate debriding of wound and, especially, at imposition of primary guy-sutures, without the clear, adjusted testimonies on this operation

8. Gunshot wound

9. Types of gunshot wounds

12. Principle chart of wound cicatrization І PHASE OF INFLAMMATION period of vascular changes Neurohumors of inflammatory reaction: amines, proteases, polipeptides Migration of leucocytes is a chemotaxis increase of vessels permeability Neurohumors of inflammatory reaction Prostaglandines F A G O C I T O Z Haemostatic reaction System of complement Factors of hemostasis system I – XIII Factor ХІІ a period of wound cleaning from tissues which perished Proteolitic enzymes: cellular, bacterial Proteolitichni and hydrolysis enzymes: bacterial, cellular system of complement ІІ PHASE OF REGENERATION FactorXIII Development of granulation tissue Е П І Т Е Л І З А Ц І Я Prolipheration of the cells Bacterial collagenaze synthesis of collogen Collagenesis of granulation tissue and epidermis Wound contration Collagenaze of granulation tissue III PHASE OF REORGANIZATION OF SCAR

13. It should be noted that mentioned physiopathology processes take place in any wound, regardless of type of its cicatrization. A difference consists only in quantitative descriptions of the mentioned phases, but not in high-quality. • Depending on it select cicatrization primary healing, second healing, through infiltrat and under a scab.

14. Differentially diagnostic signs of wound primary healing at uncomplicated motion of wound process and at suppuration of wound.

17. Surgical treatment The radical debriding of wound foresees the absolutely complete carving of all changed or staggered festering-inflammatory by the process of tissues– „races” and „pockets”, with careful hemostasis, treatment, guy-sutures, antiseptics and closing of wound defect, or one of methods of plastic surgery.

18. Types of wound healing: 1-2. first intention, 3. secondary intention, 4. under the crust.

19. The partial debriding is executed in the cases when anatomic terms (location vitally of important vascular and nervous barrels, localization of wound) or general state of patient (shock, endotoxicosis, decompensation of diabetes)does not allow to conduct radical operative interference. The last must be executed the experimental brigade of surgeons, under the general anaesthetizing in the conditions of operating-room, nowise not in chambers or bandage room.

20. PRINCIPLES OF IMPLEMENTATION OF DEBRIDING OF WOUND Dissecting of wound is on all draught; Revision of wound channel; Carving of edges of wound, its walls, bottom, necretomy; Gemostaz; Proceeding in integrity of the damaged organs and structures (by indications); Imposition of guy-sutures is on a wound with the possible draining: passive, active, running washed (by indications).

21. Methods of the improved debriding of wounds • Treatment of wound by the pulsating stream of antiseptics. • Vacuum treatment of running sore. • Treatment of running sore by the ray of laser. • Treatment of running sore by an ultrasound. • Criosurgery of running sore.

22. The basic requirements for local treatment in I phase of wound process • Wide spectrum of antimicrobial action, that conditioned : - polymorphic of microorganisms in the hearths of defeat; - it is a presence of hospital cultures of bacteria; - polyrhesistensy to many antibiotics; - relatively by the protracted terms of authentication of exciters festering-inflammatory processes and - establishment of their sensitiveness to chemical drugs;

23. Local anaesthesing and antyinflammatory action. • Hydrophilic hyperosmolar basis which is able to take in a ranoviy exsudate to 350 – 600 % during 20 - 24 hours • Preparations must not cause osmotic shock at healthy cages • Absence of local and alergic actions. • Proceeding in mycromicrocircullation in a wound, stabilizing of cellular membranes • Good spreading for wound surfaces, moistening of it and penetrations, in the wound cavities of • Ingibition of protheolitic enzymes and warning of the second necrosises

24. Improved methods of surgical treatment of wounds Ultrasonic cavitationof wound Treatment of wounds helium-neon laser

25. To that end in the period of vascular changes appoint aquasolubable antiseptics (1% solution of dioxidin, 1% solution of yodoliron, 0,02% solution of chlorhexidine, and anthers). At the increase of exudation preparations of choice are multicomponent ointments on aquasolubable basis (Levosin, Levomekol', Dioksizol', Oflokain, Nitacid and anthers.). In the second period of phase of inflammation (cleaning of wound) an important value acquires the use of sorbents (Aerovillages, Televin, Debrizan, Regenkur) and proteolitichnikh enzymes (Trypsinum, khimopsin, terrilitin).

26. The basic requirements are for local treatment in the II phase of wuond process • The reliable protecting of granulation tissues from a mechanical damage and action of other negative factors. • Prophylaxis of the second infecting of wound. Moderate drying action. • Normalization of exchange processes is due to proceeding in mycromicrocirculation. • The directed circulation of reparative processes is in a wound

27. These requirements are answered by liniments and emulsions (sintomicine, Tetracyclinum, hentamicine ointments) and preparations which stimulate regeneration (5%-10% metiluracile ointment, Solkoseril, Aktovegin and athers.). Aerosols are widely used with a anti-inflammatory and stimulant action – Oxiciklozol', Laevovinisolum, Olasolum, Panthenol.

28. The basic requirements are for local treatment in the III phase of wound process • The reliable protecting of granulation tissue is from a mechanical damage and action of other negative factors. • Prophylaxis of the second infecting of wound. • A prophylaxis of anomalous proliferation and differentiation of fibroblasts is with forming of hypertrophic and celoid scars. • Acceleration of speed of epitelisation and decline of intensity of contraktion of wound. • Directed stimulation and adjusting of reparative processes in a wound with providing of optimum terms for reorganization of scar

29. General treatment of running sore • Antibacterial therapy • Imunocorrective therapy (specific, heterospecific). • Detoxicative therapy - Infusion of crystalloids - Method of the forced diurhesis. - Application of detoxicative preparations. - Extracorporal facilities of detoxication. • Symptomatic therapy

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