How should the wound be treated?

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

In the presence of abrasions, pricks and small wounds, the damaged areas are lubricated with a 5% alcohol solution of iodine or a 2% alcohol solution of brilliant green, treated with a solution of hydrogen peroxide and a sterile bandage is applied. Small wounds and scratches can be lubricated with BF-6 glue, which disinfects the wound and protects it from further contamination. Before applying the above-mentioned products to the wound, a few drops of blood should be allowed to drain, especially after pricks. Contaminated skin should be cleaned with a piece of gauze soaked in cologne, alcohol or gasoline.

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

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General principles of wound treatment

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 (operative), 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 “equalizing and bringing together the edges of the wound so that the cut muscles, nerves, vessels, and especially the skin would be evenly adjacent to each other with their separated ends.” He then recommended “transforming a bruised wound into a cut wound and treating it quickly with a connective technique.”

Friedrich (1898) in an animal experiment established the optimal time for wound excision as 6-8 hours after its infliction. The method of wound excision was based on the principle of "outrunning infection with the surgeon's knife."

The above provisions were subsequently further developed. The method of surgical (operative) treatment was improved. The necessity of wide dissection of the wound, excision of non-viable tissues and the expediency of suturing were proven, i.e. a method of surgical treatment of the wound was developed.

A distinction is made between:

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

Primary surgical treatment of a wound involves cleaning the wound, providing pain relief, and five technical techniques for the operation itself:

1. wound dissection;
2. excision of non-viable tissue;
3. removal of loose metal and other foreign bodies from the wound;
4. stopping bleeding;
5. wound drainage or suturing.

Toilet of the wound is carried out for any injury. Using a gauze ball soaked in ether or, better, gasoline at first, clean the skin around the wound from dirt and foreign particles, lubricate the edges of the wound with iodonate, iodopyrone, it is desirable to treat the wound itself with a 1-2% solution of hydrogen peroxide, and then apply an aseptic bandage.

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

At the end of the operation, a decision is made on whether to leave the wound open or whether to apply stitches.

Primary sutures can be applied if the following conditions are met:

1. absence of visible contamination of the wound (especially with soil) and inflammatory phenomena before surgical treatment;
2. the possibility of radical excision of dead tissue and removal of foreign bodies;
3. integrity of the main vessels and nerve trunks;
4. the ability to bring the edges of the wound together without tension;
5. satisfactory general condition of the patient;
6. the possibility of leaving the wounded person under the supervision of a surgeon until the stitches are removed.

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

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

A distinction is made between early secondary sutures, which are applied to a granulating wound within 7 to 20 days, and late secondary sutures, which are applied to a scarring wound (within 20 days or later after the injury).

Good drainage is of great importance for wound healing. The following drainages are used:

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

Treatment of infected wounds

Local treatment of purulent wounds should be aimed at reducing pain, suppressing microflora, weakening the inflammatory process, and ensuring the outflow of inflammatory exudate. General therapeutic measures are taken when indicated.

The use of various therapeutic agents should be strictly selective depending on the phase of the wound healing process.

V. I. Struchkov recommends:

I. In the inflammatory phase, ensure:

1. rest for the diseased organ (immobilization, rare dressings);
2. the use of antiseptic agents, both locally and internally or intramuscularly;
3. increasing tissue hyperemia by applying dressings with a hypertonic sodium chloride solution (5-10%);
4. activation of the body's immunological responses;
5. reduction of purulent intoxication by creating a good outflow of wound exudate and a general effect on the body (infusion of blood and blood substitute solutions);
6. careful handling of the wound during dressings, since injury to its walls disrupts the protective barrier and promotes the breakthrough of infection into the internal environment of the body;
7. use of proteolytic enzymes.

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

Despite the use of all known means of general action on the body and local action on the wound, in a number of cases local and general complications arise, seriously complicating treatment and even ending in death.

Thus, wound treatment appears to be a rather complex problem. The success of rapid healing largely depends on timely and complete pre-hospital care and quickly performed primary surgical treatment of a fresh wound.

Treatment of infected and complicated wounds requires great efforts from surgical personnel and the use of all the possibilities of surgical methods, chemical and biological preparations.