Open wounds

According to the International Classification of Diseases (ISD 2010) adopted by WHO, open wounds are classified as class 19 (injuries) and have ICD 10 codes of S00-S90 and T00-T98.

Thus, open wounds of several areas of the body are designated T01.1 - T01.9, and an open wound of an unspecified area of the body is coded T14.0 - T14.1.

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Causes open wound

Open wounds include mechanical injuries to the body with different morphological parameters and a violation of the integrity of the skin: point (punctured), cut, chopped, torn, crushed, bruised, bitten, gunshot. An open wound can affect not only the skin and underlying soft tissues, but also bones, joints, blood vessels, nerves and individual organs.

When falling with sliding or friction on uneven surfaces, abrasions occur - damage to the upper layers of the skin. The pathogenesis of a punctured open wound is associated with point traumatic damage by various narrow sharp objects, i.e. punctures of the skin, mucous membrane, and soft tissues.

In case of cut and chopped wounds, damage by a sharp object in a horizontal plane (or at an angle to certain parts of the body) is combined with varying degrees of penetration into soft tissues, with simultaneous damage to blood vessels and, most often, divergence of the edges of the cut (gaping).

The causes of an open wound can also be associated with a strong bruise when a person falls, a heavy object falls on various parts of the human body, or a small object hits a person, but moves at high speed. An open lacerated wound can be caused by a fracture of the limb - when the subcutaneous tissue and skin are broken by a bone fragment that has come out.

If the damaged tissues (in particular, subcutaneous tissue and muscle fibers) completely separate from the edges of the wound, then in this case we are talking about a scalped (flap) open wound. In crushed wounds - due to very strong mechanical impact - partial or complete destruction of tissues occurs, which can affect bones, tendons, nerves and blood vessels.

As surgeons note, any traumatic damage to the skin opens up access for the adverse effects of the external environment on all internal structures in the damaged area.

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Symptoms open wound

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 damage.

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

The clinical symptoms of most types of wounds include the divergence of their opposite edges and the gaping of open internal tissues. This sign is more pronounced in cut or chopped injuries that have a transverse direction relative to the fascia and muscle fibers. Deeper structures, including internal organs, can be damaged at the same time.

The appearance of hematomas (which can become purulent) typical of bruised, crushed and bitten wounds is associated with the accumulation of blood that has escaped from damaged capillaries in the intercellular space of soft tissues. And open penetrating gunshot wounds are characterized by uneven edges with elements of necrosis, the presence of bruises, as well as the penetration of blood into the internal cavities of the body. At the same time, 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 pulse rate and loss of consciousness.

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

Complications and consequences

Among the typical and frequent negative consequences, doctors name temporary or permanent loss of functions, for example, due to damage to the tissues of the musculoskeletal system or affected internal organs; infectious complications (sepsis, gangrene); deformations from the resulting scars.

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Diagnostics open wound

A surgeon or traumatologist can easily diagnose an open wound, and to identify it, it is enough to perform an external examination of the damage and assess its extent.

In case of accidents, an open wound requires urgent medical care, first of all, stopping the bleeding by compressing the damaged vessel, as well as taking measures against pain shock. After that, the doctor needs information about what caused the wound and to determine whether there are deeper injuries. An equally important diagnostic indicator is the volume of blood loss and the general condition of the victim.

Instrumental diagnostics using radiography is carried out for open crushed and gunshot wounds - to identify the presence of foreign objects, bullets or shrapnel 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 visually assess how deeply the tissue is damaged).

In addition to a general blood test, if there is a threat or onset of purulent inflammation (before using antibiotics), tests may be required - bacteriological blood culture and biochemical examination of discharge from the wound to determine the pathogenic causative agent of the infection (Staphylococcus aureus, Streptococcus pyogenes, Enterococcus species, Clostridium septicum, Clostridium perfringtns, Proteus spp., E. Corrodens, Neisseria, Pseudomonas aeruginosa, Klebsiella spp.).

Although in clinical practice, to suppress the invasive infectious process, they simply use injections of antibiotics with a broad antimicrobial spectrum (latest generation cephalosporins in combination with semi-synthetic drugs of the penicillin group).

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Treatment open wound

Treatment of an open wound - deep stab wound, crushed wound, lacerated wound, gunshot wound, scalped wound - is carried out by a doctor. Anti-tetanus serum is mandatory, and in case of animal bites - anti-rabies immunoglobulin (against rabies).

In many cases, excision of damaged tissues is used and the wound is sutured - if there is no inflammation. However, its development is often impossible to avoid, and then surgeons have to remove the stitches and install drainage to drain the exudate accumulating in the wound cavity, or resort to drying by osmotic drainage - that is, daily application of dressings moistened with solutions of sodium chloride, magnesium sulfate or glucose.

The following medications are used to combat infection and inflammation, as well as to activate granulation processes:

• Antiseptic solutions Iodinol, Roccal, Baliz-2, Betadine, Decamethoxin, Miramistin, Tsigerol;
• Pain-relieving, anti-inflammatory and wound-healing sprays for open wounds Olazol (with anesthesin, chloramphenicol and sea buckthorn oil), Vinisol (with vinylin and linetol), Hyposol (with nipazole, methyluracil and sea buckthorn oil), Levovinizol (with chloramphenicol).
• Ointments (including under dressings): Biopin, Dioxidin, Levosin or Levonorcin (with chloramphenicol and sulfadimethoxine), Triasept or Baneocin (with bacitracin and neomycin), Streptonitol (with streptocide), Oflokain or Oflomelid (with ofloxacin and lidocaine), Sulfamyl acetate, Methyluracil, Bactroban (Bonderm, Mupirocin), Nitacid, Undecin, Vishnevsky liniment, synthomycin emulsion, etc.

To speed up the healing process of cuts, abrasions and other shallow damage to the epidermis, a colloidal gel for open wounds Feniran is intended. As indicated in the instructions, this product can be used for both dry and wet wounds - once a day, followed by the application of a sterile bandage or covering the wound surface with a plaster.

If the formation of granulation tissue in the wound is slow, you can use Kolotsil - a special sponge made of collagenase with antiseptics (furacilin and boric acid), novocaine (for local anesthesia) and chondroitin sulfuric acid in the form of honsuride (to stimulate the process of wound epithelialization). A sterile plate is applied to the surface of the wound and secured with a bandage or plaster (it is recommended to change the bandage every 2-3 days). The sponge gradually dissolves, and the wound underneath - due to granulation - heals.

Treatment of open wounds

The first and obligatory step to a successful outcome of the injury is immediate stopping of bleeding of any intensity in the most effective way: applying a tourniquet, squeezing the vessels with your fingers or applying a pressure bandage. The second step is timely treatment of open wounds in compliance with the rules of antisepsis. And the third obligatory condition: in serious cases it is impossible to do without the participation of a doctor, and in critical situations - without emergency medical personnel.

In the case of a regular scratch, it is enough to lubricate it with brilliant green, but in the case of a contaminated abrasion or any other open wound, it will need to be pre-washed. What to wash an open wound with? Medical workers recommend doing this with hydrogen peroxide (3% solution), furacilin or furocin solutions, a weak solution of potassium permanganate (manganese) or a 0.5% solution of chlorhexidine bigluconate. You can also use liquid antibacterial agents such as Dioxidine, Dekasan, Miramistin (Dezmistin) or Octenisept. Then, using a sterile napkin (or a piece of sterile bandage), the wound should be dried, and its edges should be lubricated with an alcohol solution of iodine.

A bactericidal plaster is applied to an open wound only in case of minor damage - after treating it with an antiseptic. But if the wound area is large, a napkin soaked in liquid antiseptic (not containing ethyl alcohol) is applied to it, a dry napkin should be placed on top, which should be secured with an adhesive plaster, a knitted mesh or regular gauze bandage. Deep wounds are tamponed

It should be borne in mind that dressings on open wounds should protect against additional injury and infection. Therefore, the part of the body to which the dressing is applied should be kept in the most physiological position; tight bandaging is prohibited; all dressing materials should be sterile, and the hands of the person applying the dressing should be clean.

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

Folk treatment of open wounds

It is clear that folk treatment in this situation is not always possible, although the anti-inflammatory and regenerative properties of propolis, aloe or fir oil are beyond doubt.

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

In case of an open wound, herbal treatment consists of applying compresses with decoctions and infusions of comfrey roots (larkspur) or calamus, St. John's wort, yarrow, meadowsweet, white sweet clover, orchis, oak bark, plantain leaves, raspberries, birches and alder, as well as chamomile flowers and calendula.

By the way, there is an ointment and gel based on comfrey, which contains allantoin (promoting fibroblast proliferation and extracellular matrix synthesis). The use of this ointment can significantly speed up wound healing.

And the starting material for the antibacterial drug Imanin (in the form of a powder for drying wet wounds) is St. John's wort. When this powder is mixed with Vaseline and lanolin, an antiseptic ointment is obtained (it should 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 (based on rattlesnake venom) - prevents the development of necrosis;
• Staphysagria, a remedy made from the buttercup family plant Delphinium staphisagria, is prescribed if the wound is cut;
• Ledum remedy from marsh wild rosemary – for better healing of puncture wounds;
• Arnica preparation (based on the mountain arnica plant) - stimulates blood flow in the capillaries;
• Silicea terra, a silicon-based preparation, helps the scarring process.

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Prevention

In this case, only prevention of complications is possible, which consists of following the principles of antisepsis, using appropriate medications when inflammation and suppuration develop, as well as proper care of the wound at all stages of its treatment.

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Forecast

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

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