Open wounds

According to the WHO International Classification of Diseases (ISD 2010), open wounds have the 19th grade (injuries) and the code for the ICD 10 - S00-S90 and T00-T98.

Thus, the open wounds of several areas of the body are designated T01.1 - T01.9, and the open wound of the precisely undefined body zone is encoded T14.0 - T14.1.

[1], [2], [3], [4], [5], [6], [7], [8]

Causes of the open wounds

To open wounds are various mechanical damages of the body with respect to the morphological parameters with violation of the integrity of the skin: dotted (chopped), cut, chopped, torn, crushed, bruised, bitten, gunshot. An open wound can affect not only the skin and underlying soft tissue, but also bones, joints, blood vessels, nerves and separate organs.

When falling with sliding or rubbing against uneven surfaces, abrasions occur - damage to the upper layers of the skin. The pathogenesis of a chopped open wound is associated with pinpoint traumatic injury by various narrow sharp objects, that is, punctures of the skin, mucosa, and soft tissues.

For wounds of cut and chopped lesions with a sharp object in the horizontal plane (or at an angle to those or other parts of the body), they combine with a different degree of penetration into soft tissues, with simultaneous damage to the blood vessels and, more often, a divergence of the edges of the cut (gaping).

The causes of an open wound can also be associated with a severe injury when a person falls, a heavy object falls onto different parts of a person's body, or a small object hits a person, but moves at a high speed. An open lacerated wound can be obtained by fracture of the limb - when the subcutaneous tissues and skin break through the bone fragments that come out.

If damaged tissues (in particular, subcutaneous tissue and muscle fibers) completely depart from the edges of the wound, then in this case it is a scalped (scrappy) open wound. In the case of crushed wounds - due to very strong mechanical action - a partial or complete destruction of the tissues occurs, which can affect bones, tendons, nerves and vessels.

As surgeons say, with any traumatic violation of the skin, access is provided to the adverse effect of the external environment on all internal structures in the area of damage.

[9], [10]

Symptoms of the open wounds

It should be borne in mind that the symptoms of an open wound depend on the nature and strength of the damaging factor, as well as the size, depth and location of the lesion.

The first signs of an open wound include pain and bleeding. Their intensity is also determined by the above factors: for small lesions (scratches, abrasions), the degree of pain can be minimal, with a small amount of blood extracted from the capillaries. A stab-cut, torn, gunshot wounds are accompanied by very severe pain (up to pain shock) and bleeding (often internal), which - in case of damage to large vessels - threatens a large loss of blood and is fraught with irreversible consequences for the life of the victim.

Clinical symptoms of most types of wounds include the divergence of their opposite edges and the gaping of open internal tissues. This feature is more pronounced with cut or chopped lesions, which have a transverse direction relative to the fasciae and muscle fibers. Simultaneously, deeper structures, including internal organs, can be damaged.

The appearance of bruised, smashed and bitten wounds with hematomas (which can be inflated) is associated with the accumulation of soft tissues in the intercellular space of the blood emerging from the damaged blood capillaries. And open penetrating gunshot wounds are characterized by uneven edges with elements of necrosis, the presence of bruising, as well as the penetration of blood into the internal cavity of the body. In this case, severe wounds lead to significant blood loss, which causes a drop in blood pressure, dizziness, cyanosis of the skin and mucous membranes, a change in heart rate and loss of consciousness.

If the wounds are not treated in time, as a result of bacterial infection of the subcutaneous tissue, inevitable complications arise in the form of inflammation: hyperemia of the wound area, edema, increased pain, formation of necrosis and purulent discharge with putrefactive odor, increased local temperature and general fever. This is the typical picture of open festering wounds.

Complications and consequences

Among typical and frequent negative consequences, physicians refer to temporary or permanent loss of functions, for example, in case of damage to the tissues of the musculoskeletal system or the affected internal organs; infectious complications (sepsis, gangrene); deformation from the formed scars.

[11], [12], [13], [14], [15], [16], [17], [18]

Diagnostics of the open wounds

At the surgeon or traumatologist, the diagnosis of an open wound does not cause difficulties, and for its detection, an external examination of the lesion and evaluation of its scales is sufficient.

In case of accidents, an open wound requires urgent medical attention, first of all, stopping the bleeding by clamping the damaged vessel, and also taking measures against the pain shock. After this, the doctor needs information about what the wound is inflicted, and to establish whether there are deeper damages. An equally important diagnostic indicator is the amount of blood loss and the general condition of the victim.

Instrumental diagnosis using radiography is carried out with open crushed and gunshot wounds - to detect the presence of foreign objects, bullets or a fragment and to determine the area and extent of damage, as well as in complex cases of deep punctures and cuts (when it is very difficult to assess by eye how deeply damaged tissues ).

In addition to a general blood test, when a threat or the onset of purulent inflammation (before antibiotics are used), tests - bacteriological culture of the blood and a biochemical study of the excreta from the wound to determine the pathogen causative agent of infection (Staphylococcus aureus, Streptococcus pyogenes, Enterococcus species, Clostridium septicum , Clostridium perfringtns, Proteus spp., E. Corrodens, Neisseria, Pseudomonas aeruginosa, Klebsiella spp.).

Although in clinical practice, injections of antibiotics with a broad antimicrobial spectrum (cephalosporins of the last generation in combination with semisynthetic drugs of the penicillin group) are simply used to suppress the invasive infectious process.

[19], [20], [21], [22], [23], [24], [25], [26]

Treatment of the open wounds

Treatment of an open wound - a deep stabbed-cut, smashed, torn, gunshot, scalped - is performed by a doctor. Be sure to introduce tetanus antiserum, and with animal bites - rabies immunoglobulin (against rabies).

In many cases excision of damaged tissues is applied and wound suturing is performed - if there is no inflammation. However, its development can often be avoided, and then surgeons have to remove the sutures and to drain the exudate accumulating in the wound cavity, to put drainage or resort to drainage by osmotic drainage - that is, daily application of dressings moistened with solutions of sodium chloride, magnesium sulfate or glucose.

To combat infection and inflammation, as well as to activate the processes of granulation, the following medicines are used:

• Antiseptic solutions Iodinol, Roccal, Baliz-2, Betadine, Decamethoxin, Miramistin, Tsigerol;
• Analgesic, anti-inflammatory and wound healing sprays for open wounds Olazole (with anesthesin, levomycetin and sea-buckthorn oil), Vinisol (with vinyl and linetol), Hypozol (with nipose, methyluracil and sea-buckthorn oil), Levovinisol (with levomycetin).
• Ointments (including bandages), Biopin, Dioxydin, Levosin or Levonorsin (with levomycetin and sulfadimethoxin), Triassept or Baneocin (with bacitracin and neomycin), Streptonitol (with streptocid), Oflocaine or Oflomelid (with ofloxacin and lidocaine), Sulfamylon acetate , Methyluracil, Bactroban (Bonderm, Mupirocin), Nitacid, Undecin, Vishnevsky liniment, emulsion of synthomycin, etc.

To accelerate the healing process of cuts, abrasions and other superficial injuries of the epidermis, a colloid gel is provided for the open wounds of the Feniran. As indicated in the instruction, this remedy can be used in both dry and wetting wounds - once a day, with the subsequent application of a sterile dressing or the closure of the wound surface with a patch.

If the formation of granulation tissue in the wound occurs slowly, then Kolotsil can be used - a special sponge from collagenase with antiseptics (furacilin and boric acid), novocaine (for local anesthesia) and chondroitinsulfuric acid in the form of honsuride (to stimulate the wound epithelization process). Sterile plate is superimposed on the wound surface and fixed with a bandage or plaster (it is recommended to change the bandage every 2-3 days). The sponge gradually resolves, and the wound beneath it - due to granulation - heals.

Treatment of open wounds

The first and mandatory step to the safe outcome of the resulting injury is an immediate stop of bleeding of any intensity in the most effective way: by applying a tourniquet, clamping the vessels with fingers or applying a pressure bandage. The second step is the timely processing of open wounds in compliance with the rules of antiseptics. And the third mandatory condition: in serious cases it is impossible to do without the participation of a doctor, and in critical situations - without ambulance physicians.

This with a normal scratch enough to grease it with a green, and if a contaminated abrasion and any other open wound will need its pre-rinsing. Than to wash open wound? Medical workers recommend doing this with hydrogen peroxide (3% solution), solutions of furacilin or furocin, a weak solution of potassium permanganate (manganese) or 0.5% chlorhexidine bigluconate solution. You can also use liquid antibacterial agents such as Dioxydin, Dekasan, Miramistin (Desmistin), or Octenisept. Then, using a sterile wipe (or a piece of sterile bandage), the wound should be dried, and its edges lubricated with an alcohol solution of iodine.

A bactericidal plaster on an open wound is superimposed only with minor damage - after treatment with an antiseptic. But with a large area of the wound, a napkin moistened with a liquid antiseptic (which does not contain ethyl alcohol) is applied to it, a dry napkin should be placed on top, which must be fixed with a plaster, knitted mesh or usual gauze bandage. Deep wounds swab

It should be borne in mind that dressings for open wounds should protect against additional trauma and infection. Therefore, the part of the body on which the dressing is applied should be kept in the most physiological position; tight can not be bandaged; All dressings should be sterile, and the hands of the bandage should be clean.

It is also not advisable to pull out from the wound everything that is deeply embedded in the damaged tissues: this should be done by the doctor during the surgical treatment of the injured area.

Alternative treatment of open wounds

It is clear that alternative treatment in this situation is probably not always, although the anti-inflammatory and regenerating properties of propolis, aloe or fir oil do not cause doubts.

A method of treatment of purulent wounds using a mixture of charcoal with alum, as well as turpentine emulsion (for 500 ml of boiled water 50-60 ml of pure turpentine) is described.

With an open wound, herbal treatment consists in applying compresses with decoctions and infusions of the comfrey root or marsh aureus, the herb of St. John's wort, the yarrow, the vulgaris vulgaris, the white sweet clover, the orchard, the oak bark, the leaves of the plantain, raspberry, birch and alder, and chamomile flowers and marigold.

By the way, on the basis of comfrey, containing allantoin (which promotes the proliferation of fibroblasts and the synthesis of extracellular matrix), there is an ointment and gel. The use of this ointment can significantly accelerate the healing of wounds.

And the initial raw material for the antibacterial drug Imanin (in the form of a powder for drying wetting wounds) is St. John's Wort. When mixing this powder with petroleum jelly and lanolin, an antiseptic ointment is obtained (it must be stored at + 12-15 ° C in a tightly closed jar).

For the treatment of open wounds, homeopathy offers:

• the drug Hepar sulfuris (based on calcium and sulfur) - reduces the intensity of suppuration;
• Lachesis (on the basis of rattlesnake venom) - prevents the development of necrosis;
• Staphysagria, prepared from a plant of the family Delphinium staphisagria, is prescribed if the wound is cut;
• Ledum from marsh ledum - for better healing of chipped wounds;
• the drug Arnica (based on the mountain arnica plant) - stimulates blood flow in the capillaries;
• Silicea terra based on silicon helps the scarring process.

[27], [28], [29], [30], [31], [32]

Prevention

In this case, only the prevention of complications is possible, which consists in observing the principles of antiseptics, the use of appropriate medicines in the development of inflammation and suppuration, and in the proper care of the wound at all stages of its treatment.

[33], [34], [35], [36], [37], [38]

Forecast

The consequences of open wounds and their prognosis depend on practically the same factors as the success of their treatment.

And do not forget that an open wound - depending on its location and depth - can be deadly. According to statistics, unintentional injuries with open and closed wounds account for more than 6% of all deaths worldwide.

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