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Wounds, types and treatment

  1. Gastroepato
  2. Dermatology
  3. Wounds
  4. Burns
  5. How to treat a burn
  6. Management of the patient with bedsores
  7. Management patient with bedsores

notes by dr. Claudio Italiano

Wounds

A wound is defined as a lesion of the skin or mucous membranes (for example, of the mouth, of the vagina, of the anal canal, etc.) with damage to the tissues.
A first classification is made according to whether the wound affects the superficial layers of the skin or if it deepens in the underlying tissues, therefore, skin, subcutaneous, muscle groups, tendons and even internal organs.

Also the internal organs can present wounds,  in the abdomen  or in to the thorax cavity.

Sometimes after a kickback injury, internal organs can be injured without skin injury (eg rupture of the spleen, rupture of the liver) and it is called internal wounds, to differentiate from penetrating wounds that are those in which the skin is interrupted and the lesion spreads to the internal organs, creating a path or through which connects the external environment with the cavities of the body. In this sense it is dangerous the wound of the thorax that creates a pneumo-thorax, that is the passage of a suction of air in the pleural cavity to each respiratory act, very common occurrence of the traumas of the thorax.

Another important consideration is if:
The wounds are clean (e.g. the surgical ones)
The wounds are contaminated (for example from soil, shreds of cloth, fragments of wood, debris, splinters, sand, etc.)

The wounds

In particular we will have:

Superficial wounds or abrasions (for example the child who falls and "peels" the knees and elbows, crawling the skin on the polished floor)

Wounds from irregular blunt bodies or abrasions (when there is a superficial loss of substance and material inside the wound, such as soil or splinters of wood or other debris, for example the cyclist crawling on the pavement with violence).
Other times the wounds are caused accidentally or deliberately to offend, for example in combat, with the intent to kill the enemy. It is de:
pointy wounds, for example by blade, nail, arrows etc;

they can be:
1. transfixation wounds: when they completely cross a body segment, such as a limb.
2. penetrant: when they reach one of the three cavities: cerebral, thoracic or abdominal.
3. transfoxed: when the penetrating wound has, in addition to the entry hole, also the exit wound


The pointy wound, being little painful and scarcely bleeding, and for this reason are often more dangerous than superficial and bleeding. In fact it is difficult to stabilize as deep as possible in the cavities, for example in the abdomen. This is responsible over time for fearsome complications, up to the picture of the acute abdomen.
cutting wounds, for example the knife, a broken glass that cuts the skin deeply down to the tendons!
Torn wounds, when the skin is torn, for example classically when a person is bitten by an angry dog ​​that tears the skin.
Torn and bruised wounds, for example if a blunt body has hit violently causing crushing of the tissues up to tear the skin, for example a violently punched fist with a tangential direction to the face: you tear the skin and you have the bruise tissue, so the violent pressure causes bruising, edema and wound and necrotic areas, poorly sprayed for damage to the vessels. • Avulsion wounds: for example, when the skin is not torn or bruised, but an entire organ has been removed (for example, a finger torn from a pulley, an arm with conspicuous loss of tissue shreds, for example in explosions, etc.). )
Gunshot wounds: They are wounds due to the vulnerable action of bullets fired by firearms or explosive devices.
 In the first case the wounds are characterized by a relatively small entry hole, a more or less long path and an exit hole with extroflexed margins and a larger diameter (due to the vulnerable body which in its progress creates a fragment of fragments) of tissue and bone that accompany it). The severity of the wound depends on the live strength of the projectile, the affected district, the number of organs affected. These wounds have many similarities with the pounding wounds and as these they frequently face infection and internal bleeding. At least initially the pain is modest as well as the external bleeding.
o Slash wounds resemble those ragged bruises exacerbated by the fact that the living force, in these elevated cases, can cause significant damage to the defined extreme consequences of traumatic collapse.

Treatment of wounds

The first thing to do is try to cover the wound at the accident site with sterile bandages and gauze, also to try to stop the bleeding. For this purpose, refer to the part dealing with hemorrhages and their first aid (see haemorrhages and first aid).

A very important advice is to not remove objects stuck in the skin because they could reach arteries in depth and their removal cause conspicuous hemorrhages. A removal of foreign bodies must be done to the PS.
 

The second thing to do is to clean the infected lesion well, to free it completely from the soil and the infected material contained in it (shreds of fabric, soil and sand, fragments of wood, splinters, etc.). It is also necessary to protect yourself from direct contact with the blood by using special latex gloves (see AIDS, hepatitis B and hepatitis C. To clean you use hydrogen peroxide, saline solution and soap (good mousse soap is also good) clean the wound well, then cover it with sterile gauze and use a hypoallergenic patch to cover the gauze ends around, that is along the perimeter of the gauze itself.A good antibiotic treatment is excellent, especially if the wound has been contaminated, in order to avoid the formation of abscesses or skin phlegmons

The third thing: is the subject vaccinated for tetanus? Did you do immunoprofilaxis with antitetanic immunoglobulins?
In the case of uncontaminated cutting injuries, with linear and net margins, an adequate suture, placing in a protected environment, for example in the outpatient department, some simple detached points in silk, in order to favor the combination of the margins and promote healing first intention.

The points remember that they must be removed after a few weeks. In the case of tears and / or contused wounds, the first operation is to cleanse them carefully by removing the areas mortified or frankly necrotic and to provide for the regularization of the margins. This will allow an adequate assessment of the damage and the choice of proceeding to the immediate suture of the wound, with or without the application of drainage, sometimes leaving the wound open for a second intention healing. In the case of pounding wounds it is essential to determine if they have penetrated into any cavity. The use of some tests such as ultrasound or radiography is useful for this purpose. In the presence of penetrating wounds the risk of involvement of one or more organs is very high. This confirms the decision to intervene surgically with a large exploratory laparotomy in the surgical room.

Dermatology