Methods of treatment of open wounds

The key principle on which the treatment of open wounds is based is the ability of damaged tissues of the body to reparative regeneration, that is, to restorative recovery. 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, a new tissue begins to grow on the cleaned place, covering the wound.

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Features and stages of treatment of open wounds

The treatment of open wounds is gradual and corresponds to the stages of wound process development - intracellular biochemical changes of tissues and other structures in the damage zone. According to the canons of clinical surgery, there are three such stages: primary self-purification, inflammatory reaction and tissue repair by granulation.

In the first stage, immediately after the formation of the wound and the beginning of the bleeding, the blood vessels first reflexively contract (so that the platelets can form a clot), and then expand with complete cessation of contractions (because the neurohumoral regulation of the vasoconstrictor and vasodilator nerves is blocked). In addition, the vessels in the wound area are dilated with the products of the breakdown of damaged cells. The result is a slowing of blood flow, increased vascular wall permeability and swelling of soft tissues. It is established that all this contributes to their purification, since the expansion of large vessels leads to an increase in the capillary bed and the influx of blood to the damaged area.

The second stage of the wound process is characterized by the development of an inflammatory reaction. Edema increases, there is hyperemia (due to increased blood flow). Accumulation of acidic products of destruction of the intercellular matrix of damaged tissues and red blood cells causes local acidification (metabolic acidosis) and increased synthesis of antibodies that help to 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 are killers of pathogenic bacteria), basophils (involved in inflammatory processes), and agranulocytes (which help neutrophils cleanse the body of the remains of destroyed cells and dead microbes).

During the third stage (which can begin and against the background of inflammation), proliferation of cells of a new granulation tissue takes place - in the open wound, as well as in epithelial cells - from the edges and across its surface. Gradually the granulation tissue is transformed into a connective tissue. And this stage is completed, when a wound appears on the wound site.

It is accepted to distinguish between wound healing by primary and secondary tension. The first option is realized when the wound is of minor size, its edges are maximally reduced to each other and there is no pronounced inflammation. In all steel cases, including purulent wounds, healing takes place by secondary tension.

Since the peculiarities of the treatment of open wounds depend on the degree of biochemical disorders in damaged tissues and the intensity of the restoration processes occurring in them, the task of physicians 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 bleeding and antiseptic treatment of the wound. To reduce the level of infection in washing the damaged area, peroxide, potassium permanganate, furacilin or chlorhexidine (as a solution) are used. A zelenka and iodine are needed to conduct disinfection of the edges of the wound and the skin around it. Also it is necessary to impose a sterile bandage.

The whole process of its further treatment depends on how much the wound is clean. In the medical institution with open chopped, chopped, ripped, smashed and gunshot wounds, their primary surgical treatment is performed, which experts consider mandatory. Cleaning the wound from dead, damaged or infected tissues will greatly facilitate and improve the healing process.

The surgeon removes foreign bodies and blood clots, cuts the crushed tissues and uneven edges, and then applies a seam - in order to maximize the divergent edges. In cases where the gaping of the wound does not allow to reduce the edges, it is left open, and the seams are applied later. The last step is the application of an aseptic bandage. It is also necessary to introduce serum against tetanus, and with animal bites - a vaccine against rabies.

These measures help accelerate the healing process and minimize complications (suppuration, sepsis, gangrene). And if such treatment is carried out within the first 24 hours after receiving the wound, then you can count on the maximum positive result.

Treatment of open wicking wound

If excess serous-fibrinous exudate is released, treatment of an open, wet wound should be performed.

Discharge from the wound increases with an increase in hydrostatic pressure in inflamed tissues and a decrease in the oncotic pressure of blood plasma proteins (due to the loss of albumin serum). For healing, these secretions are necessary, since they promote active phagocytosis and clean the open wound cavity. However, a sore wound requires a reduction in the accumulation of exudate - to improve the circulation of blood in the capillaries.

In this case, bandages should be changed frequently - as they become saturated with excreta.

When changing the bandage, the wound is treated with a solution of furacilin (Furozol aerosol), sodium sulfacyl salt, sodium hypochoride, gramicidin, and also liquid antiseptics such as Miramistin (Miramidez, Desmistin, Okomistin), Betadine, Oxyquinoline, Octenisept, Iodisol.

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

For application under the bandage or impregnation of tampons, Fudizin (with fusidic acid and zinc oxide), streptocid ointment, Nitacid ointment (with nitazole and streptocid) are recommended. Also to sulfonamides are antimicrobial ointments Streptonitol and Mafenide.

And Levomikol, which has been shown to promote dehydration of the wound cavity and faster tissue regeneration, includes the antibiotic levomycetin (chloramphenicol) and methyluracil (a substance with anabolic activity). Ointment is recommended either applied to sterile wipes (to fill the wound cavity), or injected directly into the wound.

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

Treatment of an open purulent wound

To treat the open purulent wound should be with the regular removal of purulent exudate, which in inflammation is formed in its cavity. Accumulations of purulent masses can not be tolerated, since they can penetrate into nearby tissues, expanding the inflammatory focus. Therefore, in the festering wounds are installed drainage systems, including - with the introduction of antibacterial drugs in the form of solutions of local action, for example, Dioxydin (Dioxysol). To anesthetize drainage procedures, local anesthetics are used: Dimexide (50% aqueous solution for tamponing), dosed Lidocaine spray, Xylocaine aerosol.

For the purpose of the biolysis of necrotic tissues and the destruction of pus in surgery, protein-splitting enzymes (proteases) are used: powdered preparations of Trypsin, Himopsin (Himopsin), Terrylitin, and suspension of Prophasim. A solution is prepared from the powder with sodium chloride and novocaine, they are moistened with sterile wipes and placed in the wound cavity (once in a day or two the napkin is changed). If purulent wounds are deep, these remedies can also be applied in a dry form.

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

Inside the wounds (after cleaning their cavity of pus) is administered a combined ointment Levosin, which includes levomitsetin, sulfadimetoksin, methyluracil and trimecaine. This tool not only kills germs and reduces the intensity of the inflammatory process, but also anesthetizes. For medicinal and occlusive dressings apply ointment Levomikol (with levomitsetinom) and liniment Synthomycin (racemic form levotsitsetina).

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

With regard to the treatment of open wounds by surgeons, the advantage of ointments is not based on petrolatum (or lanolin), but on the basis of polyethylene glycols, in particular polyethylene oxide, a water-soluble viscous high molecular weight homopolymer. It is due to the hydrophilicity of this substance that the active ingredients of the ointments penetrate deeply into the tissues and do not damage the intercellular membranes. In addition, the absence of fat, which seals the wound cavity and creates conditions for the reproduction of anaerobic infection, promotes the accelerated release of microbial toxins.

For this reason, classical ointments on petroleum jelly became less used in the treatment of wounds. Antibacterial liniment or ointment Vishnevsky (xerobes + birch tar on castor oil) pushes and speeds up its excretion, resolves infiltrates and enhances the flow of blood into the inflammation zone. Ointment is applied under the bandage - 1-2 times a day.

In hospitals, patients with open wounds are also given detoxification and immunotherapy. And ultrasound, liquid nitrogen (cryotherapy) or hyperbaric oxygenation can be used to accelerate the healing of wounds.

Treatment of open wounds at home

With small areas and superficial injuries, it is possible to treat open wounds at home. Which pharmaceuticals - other than those listed above - are most often used?

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

Streptocide (sulfonamide) is used for superficial injuries: grind the tablet to the powder state and sprinkle the wound. Keep in mind that you can apply glue BF only with scratches, small cuts and abrasions.

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

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

Zinc ointment (usually used for wet eczema and dermatitis): it can dry the abrasion with excessive exudation. The powder Imanin (from St. John's wort) will also help to dry the sore wound. A anti-inflammatory cream or spray Panthenol (dexpanthenol) can be applied only from the outside - on a scrape or burn.

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

Cream or liniment Eplan (Quotlan) on glycerine contains a complex of polyethylene glycols having disinfectant and bactericidal properties; reduces the likelihood of infection with skin lesions.

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

Treatment of open wounds by alternative means

If an insignificant level of damage allows the treatment of open wounds by alternative means, then you should use:

• the herb of St. John's wort, yarrow, heather, elecampane, feathergrass, comfrey root and aura, leaves of plantain, eucalyptus and raspberry, as well as chamomile and marigold flowers (in the form of decoctions for compresses);
• fresh aloe juice, sea buckthorn oil, rosehip oil - to lubricate the surface of shallow dry wounds;
• propolis (aqueous solution) - with wet wounds.

Also do not forget about the mummy (caprolitic or evaporite) - a powerful natural antiseptic and a reparative agent, which has long been used in the treatment of any injuries, including open wounds.