TYPES OF WOUNDSCOLLEGE OF DENTISTRY
2012-2013GENERAL SURGERY
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(PRIMARY
CLOSURE),OR DELAYED PRIMARY OR EVEN SECOND- ARY CLOSURE OR SUTURE.
TIDY & UNTIDY TYPESTIDY WOUND – PRIMARY SUTURING
UNTIDY WOUND—SUTURING AFTEREXCISION&CLEANING
OTHER CLASSIFICATION OF TYPES OF WOUNDS CLOSED & OPENED.
CLOSED WOUNDS: CONTUSION AND HAEMATOMA.BLUNT TRAUMA,NO, SKIN CUT.OPENED WOUNDS:
ABRASION:SCRAPING OF SUPERFICIAL SKIN LAYERDUE TO FRICTION.
CLOSED WOUNDSCONTUSION -- HAEMATOMA BLUNT TRAUMA—SKIN INTACT
OPEN WOUND--ABRASIONSUPERFICIAL SKIN SCRAPING DUE TO FRICTION
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 .
INCISED WOUNDS
LACERATED WOUND-IRRIGULAR EDGE
CRUSHING WOUNDSWITH OR WITHOUT FRACTURE BONES DEGLOVING SKIN AND MUSCLE CRASH
PENETRATING WOUND
BITE WOUND--CONTAMINATEDHUMAN BITE ANIMAL BITE
OPENED WOUNDS—CONT,DBITES:ANIMAL & HUMAN WITH HIGH INCIDENCE OF
INFECTION.
MISSILE INJURY WOUNDS:2 TYPES OF MISSILES: LOW VELOCITY LIKE
PISTOL;CAUSING DAMAGE ALONG THE TRACK THR-OUGH IT THE BULLET PASSED.HIGH VELOCITY MISSILE: DAMAGE A LONG THE TRACK AND AWAY FROM THE TRACK DUE TO THE SHOCK WAVE CAVITATIONAL EFFECT LIKE BONE FRAGMENTA-
TION OR LIVER SHATTERING WHEN THE MISSILE PASSES BESIDE THEM ,AND NOT NECESSARY THROUGH THEM.
PISTOL MISSILE—LOW VELOCITY
HIGH VELOCITY MISSILELOW & HIGH VELOCITY MISSILE HIGH VELOCITY MISSILE
MANAGEMENT OF WOUNDS---FIRST ABCDE RESUSSCITATION.INCLUDING
PRESSURE 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) .
WOUND MANAGEMENT---CONT,D---INSPECT THE WOUND:
CLEAN INCISED OF LESS THAN 6 HOURS DO PRIMARY SUTURING OR CLOSURE.ANY NERVE OR TENDON CUT,DO SUTURING.
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 ALL DEAD TISSUES AND DEBRIS ,AND DOFASCIOTOMY IF THE LIMB SWOLLEN & OEDEMATOUS AND PAINFUL.
THE WOUND SHOULD LEFT OPENED & CLOSE IT AFTER 4-6 DAYSOR EVEN AFTER 2 WEEKS (SECONDARY SUTURING).
TO SUTURE OR NOTIF YOU HAVE A WOUND WHICH YOU ARE IN SUSPICI-
OUN,REGARDING CLEANLINESS OR CONTAMINATION DO 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 .
TYPES OF SURGICAL WOUNDS ACCORDINGTO RATE OF INFECTION
CLEAN WOUND:HERNIA,THYROID,BREAST-INFECTION RATE 1-2%.
CLEAN CONTAMINATED:ORAL SURGERY,GASTRIC,SM-ALL BOWEL SURGERY,CHOLECYSTECTOMY-INFECTION
RATE LESS THAN 10%. CONTAMINATED WOUND: APPENDICECTOMY,
RATE OF INFECTION 15-20.% DIRTY WOUNDS:DRAINAGE OF ABSCESS,
RATE OF INFECTION LESS THAN 40%
CHRONIC WOUNDSCHRONIC ULCER-VENOUS ULCER BED SORE,PRESSURE SORE,DECUBITUS
ULCER
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