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
Potencially open
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)
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
Prevention
Surgical
Vaccination
o Tetanus toxoid
o Human
immunglobuline
/Tetig500/
o Animal serum
Rabies prophylaxe
Active immunization
Passive for
immunsuppressed
people
Thank You For The Attention