How is it necessary to treat the wound?

It is necessary to pay attention to abrasions, injections, small wounds, the so-called microtrauma brush, which occupy an important place in occupational injuries and often lead to serious consequences.

In the presence of abrasions, injections and small wounds, the damaged areas are lubricated with 5% alcohol solution of iodine or 2% alcoholic solution of brilliant green, treated with a solution of hydrogen peroxide and a sterile bandage is applied. Fine wounds and scratches can be smeared with glue BF-6, which disinfects the wound and protects it from further contamination. Before you apply the wound on the wound, you need to drain a few drops of blood, especially after injections. Dirty skin should be cleaned with a piece of cheesecloth dampened with cologne, alcohol or gasoline.

With extensive and deep wounds, it is first of all necessary to stop bleeding, disinfect skin and apply a sterile bandage, to immobilize the limb. The victim should be urgently sent to an outpatient or inpatient treatment.

[1], [2], [3], [4]

General principles of wound healing

Treatment should be aimed at rapid and smooth healing of the wound and restoration of the function of the limb or organ.

In the treatment of wounds, surgical (operational), chemical, physical and biological methods are used. The choice of method depends on the presence of a fresh or infected (inflamed) wound.

Treatment of fresh wounds

As early as 1836, A. Charukovsky recommended "equalize and bring the edges of the wound together so that the cut muscles, nerves, vessels, and especially the skin, fit evenly to each other with separated ends." Further, he recommended "a bruised wound to be turned into a cut and this treatment should be quick-connected".

Friedrich (1898), in an experiment on animals, established the optimal time for excision of the wound 6-8 hours after its application. The basis of the wound excision method was the principle "to outrun the infection through the surgeon's knife".

The above provisions were subsequently developed further. The method of surgical (operative) treatment was improved. The need for a wide dissection of the wound, excision of nonviable tissues and the feasibility of suturing, that is, a technique for surgical treatment of the wound was developed.

Distinguish:

1. early surgical treatment of the wound in the first 6 hours;
2. delayed surgical treatment of the wound - up to 24 hours;
3. late wound treatment performed in the wounded who did not receive antibiotics after 24 hours, and those receiving antibiotics - after 48 hours.

Under the primary surgical treatment of the wound is meant the execution of the wound toilet, anesthesia and five technical techniques of the operation itself:

1. dissecting the wound;
2. excision of nonviable tissues;
3. removal from the wound of free-lying metal and other foreign bodies;
4. stop bleeding;
5. drainage of the wound or suturing.

Toilet wounds are produced for any injury. By means of a gauze ball moistened with ether or, better, at first gasoline, clean the skin around the wound from dirt and foreign particles, grease the wound edges with iodonate, iodopyron, the wound itself should be treated with 1-2% hydrogen peroxide solution, and then an aseptic bandage is applied.

Depending on the severity of the injury, local or general anesthesia is performed and surgical treatment of the wound is performed.

At the end of the operation, the question of leaving the wound open or about the possibility of suturing is decided.

Primary stitches can be imposed under the following conditions:

1. absence of visible contamination of the wound (especially earth) and inflammatory phenomena prior to surgical treatment;
2. the possibility of radical excision of dead tissues and removal of foreign bodies;
3. the integrity of the main vessels and nerve trunks;
4. the possibility of rapprochement of the edges of the wound without tension;
5. satisfactory general condition of the patient;
6. The possibility of leaving the wounded under the supervision of a surgeon until the seams are removed.

If primary seams were not applied, then in the absence of signs of development of wound infection and foci of secondary necrosis, as well as a satisfactory general condition of the victim, delayed primary seams should be applied after 2-4 days after initial surgical treatment.

In those cases where the wound was not subjected to primary surgical treatment or if the treatment was of poor quality and the wound heals by secondary tension, it is sometimes useful to resort to secondary surgical treatment.

There are early secondary sutures that are applied to a granulating wound within 7 to 20 days, and late secondary sutures - they are applied to a cicatrizing wound (within a period of 20 days and later after injury).

For the healing of a wound, it is of great importance that it is well drained. Drainages are applied:

1. open. Rubber strips and tubes are used as drains;
2. closed - with hermetically sealed wounds and cavities using suction systems (the Riden method, Subbotin, etc.);
3. washing drains for prolonged irrigation of the wound with a weak solution of antiseptic.

Treatment of infected wounds

Local treatment of purulent wounds should be aimed at reducing pain, suppressing microflora, weakening the inflammatory process, ensuring the outflow of inflammatory exudate. With the testimony, general therapeutic measures are performed.

The use of various medications should be strictly selective, depending on the phase of the course of the wound process.

V. I. Struchkov recommends:

I. In the phase of inflammation, ensure:

1. rest to the sick body (immobilization, rare dressings);
2. the use of antiseptic agents, both topically and inward or intramuscularly;
3. increased hyperemia of tissues by applying dressings with hypertonic sodium chloride solution (5-10%);
4. activation of immunological reactions of the body;
5. reduction of purulent intoxication by creating a good outflow of wound exudate and the general effect on the body (infusion of blood and blood replacement solutions);
6. careful attitude to the wound during dressings, as traumatizing its walls breaks the protective barrier and promotes the breakthrough of the infection into the internal environment of the body;
7. use of proteolytic enzymes.

II. In the phase of regeneration and epithelialization, which is characterized by the fading of the inflammatory reaction, the weakening of the virulence of the infection, the reduction of the vascular reaction and exudation, the cleansing of the wound from dead tissues and the development of regeneration processes (growth of granulations), therapeutic measures should be aimed at strengthening these processes, from damage. It is necessary to widely apply bandages with indifferent ointments, to conduct general restorative therapy.

Despite the use of all known means of general effects on the body and locally on the wound, in some cases, there are local and general complications that seriously complicate treatment and even end up lethal.

Thus, the treatment of wounds is a rather difficult problem. The success of rapid cure largely depends on timely and full-fledged first aid and quickly performed primary surgical treatment of a fresh wound.

Treatment of infected and complicated wounds requires great efforts of surgical personnel and use of all the capabilities of the operational method, chemical and biological preparations.