Wounds and woundhealing Closed and open soft tissue injuries

Wounds and woundhealing Closed and open soft tissue injuries Ferenc Urbán

Injuries by the causing energy       

Mechanical trauma: open or closed injuries Thermical trauma: combustion – burning congelation – freezing Chemical trauma: coagulation colliquation Radioactive injuries Combined injuries e.g. laboratory accidents, explosions

Injuries

  

Monotrauma Multiple trauma Polytraumatization Life threatening!!!

Mechanical injuries 

Open injuries – wounds

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Potencially open

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Closed injuries

Closed mechanical injuries   

Commotion Contusion Dislaceration 

  





Distorsion Elongation Distraction Rupture

Luxation – Dislocation Fracture

Commotion 

Brain



Spinal chord

No morphological change

Contusion



Morphological changes

Dislaceration    

Distraction Elongation Distorsion Rupture

Conservative treatment

Operative treatment

Operative treatment

Dislocation

Décollement – potencially open injuries

Compartment syndrome – Volkmann’s ischemic contracture

A case of compartment syndrome after electric shock

Histology

Open mechanical injuries - wounds 

Operative wounds



Casual wounds

Wounds

  

Vulnus abrasum Excoriation Abrasion

Vulnus punctum

Vulnus scissum&caesum

Vulnus contusum

Vulnus ruptum

Vulnus lacerum

Vulnus sclopetarium   

Low velocity shot wound High velocity shot wound The force of the bullet: 

mv2 2

Vulnus morsum

Woundhealing: the aim of it   

Primary bleeding control Prevention of drying Prevention of infection

Conditions of wound healing     

Biological: Good oxygenization & blood supply Vitality of the rezidual tissues Intact innervation Acceptable macrophag function

  

Physical: Clean wound Wet, stable microclima

The forms of woundhealing 

Sanatio per primam intentionem – primary woundhealing



Sanatio per secundam intentionem – secondary woundhealing

The woundhealing process   

1. inflammatory phase (2-3 days) 2. proliferation (4-7. days) 3. reparation (from the 8th day)

Scar tissue

Woundcare (Paul Leopold Friedrich 1864-1916)     

    

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Examination of the wound for checking complications, infection control Tetanus and if it is necessary rabies prophylaxe Operation A/ Preparation of the patient and the wound for definitive treatment B/ Anaesthesia C/ Woundtoilette and excision D/ Repair of the anatomical structures E/ Dressing F/ Documentation Follow up A/ Dressing changing, „second look” B/ Removal of stitches C/ Rehabilitation

First aid

The Moberg scheme

Anaesthesia 

Total analgesia is necessary

Debridement 

Extraction of devitalized and contamined tissues, foreign bodies, etc.

Primary suture

Primary delayed suture

Secondary suture 

Early secondary suture on the 2nd week



Late secondary suture after 4-8 weeks After excision of the scar tissue

Complications     

Seroma, haematoma Dehiscentia, disruption, eventeration Hypertrophic scarformation Keloid Woundinfection

Anaerobe infections 

Emphysematous gangrene (gasgangrene)

Tetanus    o o

o

Prevention Surgical Vaccination Tetanus toxoid Human immunglobuline /Tetig500/ Animal serum

Rabies prophylaxe  

Active immunization Passive for immunsuppressed people

Thank You For The Attention