Wounds and woundhealing Closed and open soft tissue injuries

Wounds and woundhealing

Closed and open soft tissue injuries

Ferenc Urbán

Injuries by the causing energy

Mechanical trauma: open or closed injuries

Thermical trauma: combustion – burning

congelation – freezing

Chemical trauma: coagulation

colliquation

Radioactive injuries

Combined injuries e.g. laboratory accidents, explosions

Injuries

Monotrauma

Multiple trauma

Polytraumatization Life threatening!!!

Mechanical injuries

Open injuries –

wounds

Potencially open

Closed injuries

Closed mechanical injuries

Commotion

Contusion

Dislaceration

Distorsion

Elongation

Distraction

Rupture

Luxation – Dislocation

Fracture

Commotion

Brain

Spinal chord

No morphological change

Contusion

Morphological

changes

Dislaceration

Distraction

Elongation

Distorsion

Rupture

Conservative treatment

Operative treatment

Operative treatment

Dislocation

Décollement – potencially open injuries

Compartment syndrome – Volkmann’s ischemic contracture

A case of compartment syndrome after electric shock

Histology

Open mechanical injuries - wounds

Operative wounds

Casual wounds

Wounds

Vulnus abrasum

Excoriation

Abrasion

Vulnus punctum

Vulnus scissum&caesum

Vulnus contusum

Vulnus ruptum

Vulnus lacerum

Vulnus sclopetarium

Low velocity shot

wound

High velocity shot

wound

The force of the bullet:

mv2

2

Vulnus morsum

Woundhealing: the aim of it

Primary bleeding

control

Prevention of drying

Prevention of infection

Conditions of wound healing

Biological:

Good oxygenization &

blood supply

Vitality of the rezidual

tissues

Intact innervation

Acceptable

macrophag function

Physical:

Clean wound

Wet, stable microclima

The forms of woundhealing

Sanatio per primam

intentionem – primary

woundhealing

Sanatio per secundam

intentionem –

secondary

woundhealing

The woundhealing process

1. inflammatory phase (2-3 days)

2. proliferation (4-7. days)

3. reparation (from the 8th day)

Scar tissue

Woundcare (Paul Leopold Friedrich 1864-1916)

Examination of the wound for checking complications, infection control

Tetanus and if it is necessary rabies prophylaxe

Operation

A/ Preparation of the patient and the wound for definitive treatment

B/ Anaesthesia

C/ Woundtoilette and excision

D/ Repair of the anatomical structures

E/ Dressing

F/ Documentation

Follow up

A/ Dressing changing, „second look”

B/ Removal of stitches

C/ Rehabilitation

First aid

The Moberg scheme

Anaesthesia

Total analgesia is

necessary

Debridement

Extraction of devitalized and contamined

tissues, foreign bodies, etc.

Primary suture

Primary delayed suture

Secondary suture

Early secondary

suture on the 2nd

week

Late secondary suture

after 4-8 weeks

After excision of the

scar tissue

Complications

Seroma, haematoma

Dehiscentia, disruption, eventeration

Hypertrophic scarformation

Keloid

Woundinfection

Anaerobe infections

Emphysematous

gangrene

(gasgangrene)

Tetanus

Prevention

Surgical

Vaccination

o Tetanus toxoid

o Human

immunglobuline

/Tetig500/

o Animal serum

Rabies prophylaxe

Active immunization

Passive for

immunsuppressed

people

Thank You For The Attention