Treatment methods for open wounds

The key principle underlying the treatment of open wounds is the ability of damaged tissues of the body to reparative regeneration, i.e., compensatory restoration. But before the tissues in the wound cavity begin to recover, it is necessary that there are no dead cells in the damaged area. Only after this does new tissue begin to grow in the cleaned area, covering the wound.

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Features and stages of treatment of open wounds

Treatment of open wounds is staged and corresponds to the stages of development of the wound process - intracellular biochemical changes in tissues and other structures in the area of damage. According to the canons of clinical surgery, there are three such stages: primary self-cleaning, inflammatory reaction and tissue restoration by granulation.

At the first stage, immediately after the wound has formed and bleeding has begun, the blood vessels first reflexively contract (so that the platelets have time to form a clot), and then expand with a complete cessation of contractions (since the neurohumoral regulation of the vasoconstrictor and vasodilator nerves is blocked). In addition, the vessels in the wound area are expanded by the decay products of damaged cells. The result is a slowdown in blood flow, increased permeability of the vascular walls, and swelling of soft tissues. It has been established that all this contributes to their purification, since the expansion of large vessels leads to an increase in the capillary bed and an influx of blood to the damaged area.

The second stage of the wound healing process is characterized by the development of an inflammatory reaction. The swelling increases, hyperemia appears (due to increased blood flow). The accumulation of acidic products of destruction of the intercellular matrix of damaged tissues and red blood cells causes a local increase in acidity (metabolic acidosis) and increased synthesis of antibodies that help remove dead cells from the body. Moreover, bleeding and inflammation increase the level of leukocytes in the blood. And leukocytes are neutrophils (the main phagocytes - killers of pathogenic bacteria), basophils (participate in inflammatory processes) and agranulocytes (help neutrophils cleanse the body of the remains of destroyed cells and dead microbes).

During the third stage (which can also begin against the background of inflammation), there is a proliferation of new granulation tissue cells - in the open wound, as well as epithelial cells - from the edges and over its entire surface. Gradually, the granulation tissue is transformed into connective tissue. And this stage ends when a scar appears at the site of the wound.

It is customary to distinguish between wound healing by primary and secondary intention. The first option is realized when the wound is of small size, its edges are maximally brought together and there is no pronounced inflammation. In all steel cases, including purulent wounds, healing occurs by secondary intention.

Since the specifics of treating open wounds depend on the degree of biochemical disturbances in damaged tissues and the intensity of the recovery processes occurring in them, the task of doctors is to correct and, if necessary, stimulate these processes.

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The Importance of Primary Treatment in the Treatment of Open Wounds

The first pre-medical actions are reduced to stopping the bleeding and antiseptic treatment of the wound. To reduce the level of infection, peroxide, potassium permanganate, furacilin or chlorhexidine (in the form of a solution) are used to wash the damaged area. And brilliant green and iodine are needed to disinfect the edges of the wound and the skin around it. A sterile bandage should also be applied.

The entire process of its further treatment depends on how clean the wound is. In a medical institution, with open stab, cut, lacerated, crushed and gunshot wounds, their primary surgical treatment is carried out, which specialists consider mandatory. Cleaning the wound from dead, damaged or infected tissue will greatly facilitate and improve the healing process.

The surgeon removes foreign bodies and blood clots, excises crushed tissue and uneven edges, and then applies a suture to bring the separated edges as close as possible. In cases where the gaping wound does not allow the edges to be brought together, it is left open and sutures are applied later. The last stage is the application of an aseptic bandage. Anti-tetanus serum is also mandatory, and in the case of animal bites, a rabies vaccine.

These measures help speed up the healing process and minimize complications (suppuration, sepsis, gangrene). And if such treatment is carried out within the first day after receiving the wound, then you can count on the maximum positive result.

Treatment of an open weeping wound

If there is an excess of serous-fibrinous exudate, treatment of an open weeping wound should be carried out.

Wound discharge increases with increasing hydrostatic pressure in inflamed tissues and decreasing oncotic pressure of blood plasma proteins (due to loss of serum albumin). These discharges are necessary for healing, as they promote active phagocytosis and cleanse the cavity of the open wound. However, a weeping wound requires a reduction in exudate accumulation – to improve blood circulation in the capillaries.

In this case, the dressings should be changed frequently as they become soaked with secretions.

When changing the dressing, the wound is treated with a solution of furacilin (Furasol aerosol), sodium sulfacyl, sodium hypochloride, gramicidin, as well as liquid antiseptics such as Miramistin (Miramidez, Desmistin, Okomistin), Betadine, Oxyquinoline, Octenisept, Iodisol.

To reduce the level of exudate in a weeping wound, open wounds are treated with table salt: a bandage is applied, moistened with a 10% aqueous solution of sodium chloride (due to the combined action of chlorine and sodium ions, the osmotic pressure of the interstitial fluid is normalized). In this case, the bandage should be changed every 4-5 hours.

For application under a bandage or soaking tampons, Fudizin gel (with fusidic acid and zinc oxide), streptocide ointment, Nitacid ointment (with nitazole and streptocide) are recommended. Also, sulfonamides include the antimicrobial ointments Streptonitol and Mafenide.

And the composition of the Levomekol ointment, which, as practice has shown, promotes dehydration of the wound cavity and faster tissue regeneration, includes the antibiotic levomycetin (chloramphenicol) and methyluracil (a substance with anabolic activity). The ointment is recommended to be either applied to sterile napkins (to fill the wound cavity) or injected directly into the wound.

To dry out weeping wounds, Xeroform powder (bismuth tribromophenolate), which also has bactericidal properties, or Baneocin (with the antibiotic neomycin and zinc bacitracin) are also used.

Treatment of an open purulent wound

Treatment of an open purulent wound should be carried out with regular removal of purulent exudate, which forms in its cavity during inflammation. Accumulation of purulent masses should not be allowed, as they can penetrate into nearby tissues, expanding the inflammatory focus. Therefore, drainage systems are installed in purulent wounds, including the introduction of antibacterial drugs in the form of local solutions, for example, Dioxidine (Dioxizole). Local anesthetics are used to relieve pain during drainage procedures: Dimexide (50% aqueous solution for tamponade), dosed Lidocaine spray, Xylocaine aerosol.

In order to biolyze necrotic tissue and destroy pus, protein-splitting enzymes (proteases) are used in surgery: powdered preparations Trypsin, Chymopsin (Chymopsin), Terrylitin, as well as Profezim suspension. A solution with sodium chloride and novocaine is prepared from the powder, sterile napkins are moistened with it and placed in the wound cavity (the napkin is changed every 1-2 days). If purulent wounds are deep, these agents can also be used in dry form.

In addition, to combat pathogenic microorganisms and the development of secondary infectious inflammation in inpatient settings, antibiotics are used both for oral administration (or by injection) and antibacterial ointments for the treatment of open wounds.

The combined ointment Levosin, which contains levomycetin, sulfadimethoxine, methyluracil and trimecaine, is injected into the wounds (after cleaning their cavity from pus). This agent not only kills microbes and reduces the intensity of the inflammatory process, but also relieves pain. For medicinal and occlusive dressings, Levomekol ointment (with levomycetin) and liniment Sintomycin (racemic form of levocicetin) are used.

Ointments with the antibiotic neomycin (Baneocin) are most effective against Staphylococcus aureus, ointments with nitazole (Nitacid) are most effective against anaerobic microbes, 5% Dioxidine ointment is most effective against many pathogenic microorganisms, including Pseudomonas aeruginosa and gangrene pathogens.

In terms of treating open wounds, surgeons have recognized the advantage of ointments based not on Vaseline (or lanolin), but on polyethylene glycols, in particular, polyethylene oxide - a water-soluble viscous high-molecular homopolymer. It is due to the hydrophilicity of this substance that the active components of ointments penetrate deep into tissues and do not damage intercellular membranes. In addition, the absence of fat, which seals the wound cavity and creates conditions for the proliferation of anaerobic infection, promotes the accelerated removal of microbial toxins.

For this reason, classic ointments on Vaseline have become less common in the treatment of wounds. Antibacterial liniment or Vishnevsky ointment (xeroform + birch tar on castor oil) dissolves pus and accelerates its removal, resolves infiltrates and increases blood flow to the inflammation zone. The ointment is applied under a bandage - 1-2 times a day.

In hospitals, patients with open wounds also receive detoxification and immunotherapy. And ultrasound, liquid nitrogen (cryotherapy), or hyperbaric oxygen may be used to speed up wound healing.

Treating Open Wounds at Home

For small and shallow injuries, open wounds can be treated at home. What pharmaceuticals - other than those listed above - are used most often?

Salicylic acid contained in Salicylic ointment is an antiseptic; the ointment should be applied to the wound (after treatment with hydrogen peroxide), then a sterile bandage should be applied. Ichthyol ointment (with petroleum jelly) is used in the same way.

Streptocide (sulfanilamide) is used for superficial injuries: crush the tablet to a powder and sprinkle it on the wound. Keep in mind that BF glue can only be used for scratches, small cuts and abrasions.

Rescuer balm (with milk lipids, sea buckthorn, terpene and lavender oils, tea tree oil, echinacea extract, tocopherol and beeswax) forms a film on the surface of the epidermis. Therefore, Rescuer ointment should be applied to an open wound after treating it with the same peroxide or chlorhexidine and drying it.

Solcoseryl (belongs to the group of biogenic stimulants): the ointment is recommended to be applied twice a day to dry wounds, and the jelly to wet wounds.

Zinc ointment (usually used for weeping eczema and dermatitis): can dry out abrasions with excessive exudation. Imanin powder (from St. John's wort) can also help dry out a weeping wound. And the anti-inflammatory cream or spray Panthenol (dexpanthenol) can only be applied externally - to abrasions or burns.

Troxevasin ointment (intended for patients with varicose veins), Heparin ointment (used for thrombophlebitis of superficial veins), Dolobene gel (heparin + dimethyl sulfoxide + dexpanthenol) can help relieve tissue swelling and bruises after a bruise. Badiaga is used for the same purpose.

Cream or liniment Eplan (Quotlan) on glycerin contains a complex of polyethylene glycols, which have disinfectant and bactericidal properties; reduces the likelihood of infection in case of skin damage.

Homeopathic ointment Traumeel (containing arnica, echinacea, belladonna, witch hazel, comfrey and other herbal ingredients) is used to relieve pain and bruises from contusions, sprains, and fractures.

Treatment of open wounds with folk remedies

If the level of damage is minor and allows for open wounds to be treated with folk remedies, then the following should be used:

• St. John's wort, yarrow, heather, elecampane, fireweed, comfrey and calamus root, plantain, eucalyptus and raspberry leaves, as well as chamomile and calendula flowers (in the form of decoctions for compresses);
• fresh aloe juice, sea buckthorn oil, rosehip oil – for lubricating the surface of shallow dry wounds;
• propolis (aqueous solution) – for weeping wounds.

Also, don’t forget about mumiyo (caprolite or evaporite) – a powerful natural antiseptic and reparative agent that has long been used in the treatment of any injuries, including open wounds.