m.d. Shydlovscky. A.V.

Genesis ( reasons of origin). Degree of infecting. Character of wound. Attitude toward the cavities of body.

Motion of wound channel.

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

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.

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.

1. Area of primary wound channel, which is diagnosed clinically at once after a wound;

2. 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;

3. 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

Principle chart of wound

cicatrization

І PHASE OF INFLAMMATION

period of vascular changes

increase of vessels permeability

Haemostatic reaction

a period of wound cleaning from tissues which perished

Migration of leucocytes is a chemotaxis

F A G O C I T O Z

Neurohumors of inflammatory reaction: amines, proteases, polipeptides

Factors of hemostasis

system I – XIII

ІІ PHASE OF REGENERATIONsystem of

complement

Development of granulation tissue

III PHASE OF REORGANIZATION OF SCAR

Collagenazeof granulation tissue

Bacterial collagenaze

Prolipheration of the cells

synthesis of collogen

Wound contration

ЕПІТЕЛІЗАЦІЯ

Factor XIII

Prostaglandines

Proteolitic enzymes: cellular, bacterial

Collagenesis of granulation tissue

and epidermis

Neurohumors of inflammatory reaction

System of complement

Factor ХІІ

Proteolitichni and hydrolysis enzymes: bacterial, cellular

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.

Criteria of estimation

Uncomplicated motion Motion, complicated by suppuration

GENERAL

1.General condition

2.Pain

3.Temperature of body

4.General blood analysis

Insignificantly worsened after a wound, normalized on 2-3 days. Sleep is not broken.Moderate, on 2-3 days

disappearsRises after an operation

to 37,5-38 0 C, normalized on 2-3 daysThe acceleration of BSR

to 15-20 mm/h, insignificant change, at complete normalization on 6-7 days

An improvement does not take place, pains proceed, that violates sleep.

Intensive, often pulsating

Increase to 38-390S, or proof subfibrilitet (37,2-37,6 0C)

All changes grow, or absence of positive dynamics.

ІІ. LOCAL1. A lymphangitis limfadenit

2. Hyperemia

3. Edema

4. Infiltration of tissues

5. Selection.

It is not observed

Insignificant, disappears quickly

Insignificant, disappears quickly

Insignificant, disappears quickly

It is not practically

It is observed more frequent at the defeat of extremities

Moderate, or expressed, without a positive dynamics

Moderate, often making progress

Moderate, grows often, festering infiltrat is determined

Serosal exsudate, quickly passes to festering

ІІІ. KLINIKO-LABORATORY1. Bacteriological control

2. Рh of wound content

3. An amount of albumen is in an exsudate from a wound4. Cytology

5. Thermography

Growth is not, or sometimes microbal number < 105

Early acidosis of wound environment (Ph from 5,0 till 8,0)

Quickly diminishes from 15-25 till 2-6 g/l

The cellular elements of blood, neytrophiles, are kept. Appearance of poliblasts, fibrocytes, fibroblasts.

Most intensity is on 2-5 days. A decline of t0 is from 6-8 days.

Growth is marked. Microbal number> 105

Proof acidosis(Ph< 7,0)

Grows or stably at level 10-20 g/l

Mainly neytrofiles in destruction of different degree.

Acute increase t0 > 1,5-20С.

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.

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

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.

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).

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.

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;

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

Treatment of woundshelium-neon laser

Ultrasonic cavitation of wound

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).

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

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.

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

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