GYÖRGYI SZABÓ ASSISTANT PROFESSOR DEPARTMENT OF SURGICAL RESEARCH AND TECHNIQUES 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 1
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GYÖRGYI SZABÓASSISTANT 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
1
WOUND
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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, traumaticIt can be mild, severe, or even lethal.
Simple wound Compound wound
AcuteChronic
3
Parts of the wound
Wound edge Woundcorner
Surface of the wound
Base of the wound
Cross section of a simple wound
Skin surface
Subcutaneus tissue
Superficial fascia
Muscle layerBase of the wound
Wound edge
Surface ofthe wound
Woundcavity
4
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 stabilizationB: BreathingC: CirculationD: DisabilityE: Environment and Exposure
5
Wound management - anamnesis
When and where was the wound occured?Alcohol and drug consumptionWhat did caused the wound?The circumstances of the injuryOther diseases eg. diabetes mellitus, tumour,
atherosclesosis, allergyThe state of patient’s vaccination against TetanusPrevention of rabiesThe applied first-aid
6
Classification of the accidental wounds1. 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 negligibleBUT Anaerobic infection Injury of big vessels and
nerves
Mechanical wounds8
3.) Incised wound(v. scissum)
4.) Cut wound (v. caesum)
Sharp object Best healing
Sharp object + blunt additional force
Edges - uneven
Mechanical wounds9
5.) Crush wound(v. contusum)
6.) Torn wound (v. lacerum)
Blunt force Pressure injury Edges – uneven and torn Bleeding
In a luminar organ (hematuria, hemoptoe, melena) In body cavities (intracranial, hemothorax, hemascos,
hemopericardium, hemarthros) Among the tissues (hematoma, suffusion)
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Bleeding
Preoperative hemorrhagePrehospital care! – maintenance of the airways, ventillation and circulationbandages, direct pressure, turniquets
Intraoperative hemorrhageanatomical and/or diffusedepending on the surgeon, the surgery, position,the size of the vessel, pressure in the vesselANESTHESIA!
Postoperative bleedingineffective local hemostasis, undetected hemostatic defect, consumptive coagulopathy or fibrinolysis
44
Local General
Hematoma, suffusion, ecchymosis
Compression in the pleural cavity, in pericardium, in the skull
Functional disturbancies – e.g. hyperperistalsis
Pale skin, cyanosis, decreased BP. and tachycardia, difficulty in breeding, sweeting, decreased body temperature, unconsciousness, cardiac and laboratory standstill, laboratory disorders, signs of shock
Signs of the bleeding45
Surgical hemostasis
Aim – to prevent the flow of blood from the incised or transected vessels
Mechanical methodsThermal methodsChemical and biological methods
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Surgical hemostasisMechanical methods
Digital pressure – direct pressure, e.g. Pringle maneuverTourniquetLigationSuturingPreventive hemostasisClipsBone waxother
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Thermal methods
Low temperature Hypothermia – eg. stomach bleeding Cryosurgery
dehidratation and denaturation of fatty tissue decreases the cell metabolism vasoconstriction
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Thermal methods
High temperature Electrosurgery – electrocauterization Monopolar diathermy Bipolar diathermy
Laser surgerycoagulation and vaporizationfor fine tissues
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Thermal methods
High temperature Electrocoagulation Electrofulguration (A) Electrodessication Electrosection