Scab wound wounds

The diagnosis of perforating injury of the sclera is sometimes not easy to put, if there is no x-ray contrast in the eye or visible through the pupil and the pedigree body, there is no gaping of the wound edges that are covered with edematous or blood-soaked conjunctiva, loss of internal membranes or vitreous body.

A perforated injury of the sclera, unlike the wounds of the cornea, behind which a rather deep anterior chamber is located, very rarely can be uncomplicated, i.e., do not accompany damage to deeper tissues (the uveal tract, the retina, the vitreous). During the surgical treatment it is possible to establish the depth and extent of the scleral wound. Under the control of the operating microscope, follow all the branches of the wound - to the areas of intact sclera. Since the sclera wounds have their conjunctival coverage and are in contact with the vascular tract in the depth, they stick together faster than the corneal tracts, they never fistulate and are surrounded early by newly formed vessels.

Surgical treatment begins with the application of 1-2 bridle sutures to those straight muscles, the pulling of which can lead to the area of injury in the projection of the eye gap. Then the conjunctival wound is released from blood clots of fibrin films and mucus with cotton swabs and smooth tweezers. When the configuration of the wound is determined completely, the main (shaping) seams from capron 04-05 are applied. First of all, the corners of the wound are pulled up by scrapers, or simply extended wounds are divided into shorter lengths. Then loops of these stitches once lead, the dropped out tissue is cut off with sharp microscissors and the preliminary sutures are immediately tied, which prevents the loss of contents. On non-woven yet branching wounds, nodular stitches from silk 08 are superimposed. If the wound is very large and stretches to the posterior pole of the eye, then the stitches are applied in stages.

Probing injuries of the sclera with the deposition of the vitreous body. And with a small scleral injury it is necessary to excise the fallen vitreous body, therefore, during surgical treatment, the scarring stroma of the vitreous body is cut behind the retina in the wound region. This is achieved by moderate (by 2-3 mm) compression of all the membranes over the sealed wound by filing an episcleral seal from silicone rubber. Flap seams made of woven lavsan or myron are held no closer than 4-5 mm from the edges of the wound, and deep enough, after restoration of the eye turgor, by any of the vitreous substitutes with the addition of antibiotics and corticosteroids. This procedure reduces the likelihood of subsequent traction detachment of the retina.

On the surface of the filling and sclera in the wound area, a flap of a preserved solid brachial rim is laid and strengthened with 3-4 silk sutures of 08 to the episclerus.

[1], [2], [3], [4]

Perforated sclera wound with tissue defects

If a defect is detected during the treatment of the sclera wound, it can be placed in a piece of tissue (sclera, dura mater) corresponding in shape. A sclera defect indicates severe damage to the entire eye, including the retina, so the intervention is rather a cosmetic, organ-preserving procedure aimed at restoring visual functions in the damaged eye. The complexity of this intervention is that the wound is sutured with a noticeable violent deviation of the eye from its normal, middle position in the orbit, and this deforms the fibrous capsule, increases the turgor of the eyeball and ultimately provokes a massive infiltration of the vitreous body from the gaping wound.