Bài giảng lớp y sỹ wound emergency

Classification and management of
wound, principle of wound healing,
haemorrhage and bleeding control
1

GYÖRGYI SZABÓ
ASSISTANT PROFESSOR

DEPARTMENT OF SURGICAL
RESEARCH AND TECHNIQUES

Basic Surgical Techniques, Faculty of Medicine, 3rd year
2021/13 Academic Year, Second Semester


2

WOUND


What is a wound?
3

 It is a circumscribed injury which is caused by an

external force and it can involve any tissue or organ.
surgical, traumatic
It can be mild, severe, or even lethal.
Simple wound
Compound wound
Acute

Chronic


Parts of the wound
4

Wound edge

Wound
corner
Surface of
the wound
Base of the wound

Cross section of a simple wound
Wound edge
Wound
cavity
Surface of
the wound
Base of the wound

Skin surface
Subcutaneus tissue
Superficial fascia
Muscle layer


The ABCDE in the injured assessment
5

The mnemonic ABCDE is used to remember the
order of assessment with the purpose to treat
first that kills first.
 A: Airway and C-spine stabilization
 B: Breathing
 C: Circulation
 D: Disability
 E: Environment and Exposure


Wound management - anamnesis
6

 When and where was the wound occured?
 Alcohol and drug consumption
 What did caused the wound?
 The circumstances of the injury
 Other diseases eg. diabetes mellitus, tumour,

atherosclesosis, allergy
 The state of patient’s vaccination against Tetanus
 Prevention of rabies
 The applied first-aid


Classification of the accidental wounds
1. Based on the origine
7

Mechanical wounds
8

1.) Abraded wound
(v. abrasum)

2.) Punctured wound
(v. punctum)

 Superficial part of the

 Sharp-pointed object
 Seems negligible

epidermal layer
 Good wound healing

BUT
 Anaerobic infection
 Injury of big vessels and
nerves


Mechanical wounds
9

3.) Incised wound
(v. scissum)

4.) Cut wound (v. caesum)

 Sharp object

 Sharp object + blunt

 Best healing

additional force
 Edges - uneven


Mechanical wounds
10

6.) Torn wound
(v. lacerum)

5.) Crush wound
(v. contusum)





Blunt force
Pressure injury
Edges – uneven and torn
Bleeding

 Great tearing or pulling
 Incomplete amputation

(v. lacerocontusum)


Mechanical wound
11

7.) Shot wound (v. scolperatium)
 Close - burn injury
 Foreign materials

aperture

output
slot tunel

unijured tissue
necrobiotic zone
necrotic zone
foreign bodies


Mechanical wounds
12

8.) Bite wound (v. morsum)
 Ragged wound
 Crushed tissue

 Torn
 Infection
 Bone fracture
 Prevention of rabies
 Tetanus profilaxis


The direction of the flap
13

Distal

Proximal

The wound healing is good


Chemical wounds
14

1.) Acid
 in small concentration – irritate
 in large concentration –

coagulation necrosis

2.) Base
 colliquative necrosis

Wounds caused by radiation
15

Symptoms and severity
depend on:
 Amount of radiation
 Length of exposure
 Body part that was exposed
Symptoms may occur
immediately, after a few days,
or even as long as months.
What part of the body is most
sensitive during radiation
sickness?

bone marrow
gastrointestinal tract


Wounds caused by thermal forces
16

1.) Burning
Metabolic change! - toxemia
 a – normal skin

1 - 1st degree – superficial injury
(epidermis)
 2 – 2nd degree –partial or deep partial
thickness (epidermis+superficial or

deep dermis)
 3 – 3rd degree – full thickness
(epidermis + entire dermis)
 4 – 4th degree – (skin + subcutaneous
tissue + muscle and bone)




Treatment:



Cooling – cold water and clean covering

2.) Freezing
 mild, moderate, severe (redness,

bullas, necrosis)
 rewarm – not only the frozen area
but the whole body


Special wounds
17

Exotic, poisonous animals
 Toxins, venom -

toxicologist

 Skin necrosis


Classification of the wounds
2. According to the bacterial contamination
18

 Clean wound
 Clean-contaminated wound
 Contaminated wound
 Heavily contaminated wound


Classification of the wounds
2. Depending on the depth of injury
19

 Superficial
 Partial thickness
 Full thickness
 Deep wound

+ bone, opened cavities, organs…etc.

source: />

Wound management - history
20

 Ancient Egypt – lint (fibrous base-wound site closure), animal grease (barrier)

and honey (antibiotic)
„closing the wound preserved the soul”
 Greeks – acute wound= „fresh” wound; chronic wound = „non-healing” wound
maintaining wound-site moisture
 Ambroise Paré – hot oil ↔ oil of roses and turpentine, ligature of arteries
instead of cauterization
 Lister pretreated surgical gauze – Robert Wood Johnson →1870s; gauze and
wound dressings treated with iodide


Applied wound management colour continuum
21

black

black-yellow

yellow

yellow-red

source: Applied wound management supplement – www.wounds-uk.com

red

red-pink

pink

Applied wound management
infection continuum
22

the quantity and diversity of microbes

contamination
sterility

critical colonisation

colonisation

source: Applied wound management supplement – www.wounds-uk.com

infection


Applied wound management
exudate continuum
23

Viscosity
volume

high - 5

medium - 3 low - 1

high - 5
medium -3
low - 1

source: Applied wound management supplement – www.wounds-uk.com


The wound managemanet
24

 Temporary wound management (first aid)
 clean, hemostasis, covering
 Final primary wound management
 clean, anaesthesis, excision, sutures
 ALWAYS: thoracic cavity, abdominal wall or dura mater injury
 NEVER: war injury, inflammation, contamination, foreign
body, special jobs,
bite, shot, deep punctured wound
 Primary delayed suture (3-8 days)
 clean, wash – saline, cover
 excision of wound edges, sutures


The wound managemanet
25

 Early secondary wound closure (2 weeks)
 after inflammation, necrosis – proliferation
 anesthesia, refresh wound edges, suturing and draining
 Late secondary wound closure (4-6 weeks)

 anesthesis, scar excision, suturing, draining
 greater defect – plastic surgery