Wounds, surgical; traumatic
General Surgery Wounds, surgical; traumatic Dr. Ziad H. Delemi
B.D.S, F.I.B.M.S (M.F.) Mosul university- College of dentistry-oral
& maxillofacialsurgery department Surgical incisions Incision:
A cut produced surgically by a sharp instrument that creates an
opening into an organ or space in the body. Rules of surgical
incisions: Accessibility Extensibility Security Esthetic ( previous
scar ) Rapidity Parallel to skin creases Built of the patient Mosul
university- College of dentistry-oral & maxillofacialsurgery
department Surgical incisions Principles in doing surgical
incisions:
A sharp knife should always be used. One stroke throughout the
required distance. The blade held perpendicular to the skin
surface. A fresh new knife used to incise deeper layers to avoid
contamination. Adequate length should always be used. Mosul
university- College of dentistry-oral & maxillofacialsurgery
department Surgical incisions types: Abdominal incisions:-vertical:
midline
--paramedian --pararecus -transverse -obliquegridiron --subcostal
Mosul university- College of dentistry-oral &
maxillofacialsurgery department Surgical incisions 2-
Abdominothorasic
3- head & neck & face: -bicoronal -submandibular -Weber
Fergusson -trachiostomy -radical neck MacAfee - thyriodectomy 4-
breast : mastectomy, circumareolar 5- chest wall & back
incisions Mosul university- College of dentistry-oral &
maxillofacialsurgery department Mosul university- College of
dentistry-oral & maxillofacialsurgery department Surgical
&Traumatic Wounds
Wound : is a break or loss of continuity of skin or mucus membrane
. Causes: Iatrogenic surgical incisions Traumatic RTA, assault, war
injury Types: 1- incised wound: due to sharp instrument ,
relatively clean 2- lacerated wound: due to RTA, machinery
accidents. 3- crushed wound: due to war injury. 4- puncture wound:
penetrating or perforated 5- avulsed wound: shell injury Mosul
university- College of dentistry-oral & maxillofacialsurgery
department Surgical &Traumatic Wounds
Mosul university- College of dentistry-oral &
maxillofacialsurgery department Surgical &Traumatic
Wounds
Mosul university- College of dentistry-oral &
maxillofacialsurgery department Surgical &Traumatic
Wounds
Classification of Surgical Wounds According to Degree of
Contamination: Class I: Clean wound, like surgical incisions that
are made electively during surgical procedures in an aseptic
environment. Class II: Clean contaminated wound, the kind of
aseptic elective surgical incision that is made in a contaminated
environment, like oral cavity, as it normally contains huge number
oral flora carried in saliva. Class III:Contaminated wounds and
those usually are not elective but traumatic in origin like fresh
skin lacerations, opened fractures and penetrating wounds. Class
IV: It is a dirty contaminated wound, usually contains devitalized
tissue or preexisting infection prior to operation Mosul
university- College of dentistry-oral & maxillofacialsurgery
department Surgical healing Pathology of wound healing:
1- small blood or fibrin clot 2- epithelization 3- wound
contraction 4- fibrosis & scar formation Mosul university-
College of dentistry-oral & maxillofacialsurgery department
Surgical healing Types of wound healing:
1-primary intension: seen when the wound is brought in anatomical
layers & approximated by sutures, staples, clips, adhesive
glue, steristrips. 2-secondary intension: seen when the wound
layers cannot be approximated due to big wound or skin loss or
ulcer so it will be heal by contraction epithelization granulation
tissue slow healing ugly scar. Mosul university- College of
dentistry-oral & maxillofacialsurgery department Surgical
healing Factors affecting the wound healing General factors:
1-hypovitaminosis A& D. 2-malnutrition, uremia, jaundice, DM.
3- hematological diseases leukemia, lymphoma. 4- malignant diseases
catchexia, chemotherapy. 5- chronic generalized diseases TB,
ulcerative colitis. Mosul university- College of dentistry-oral
& maxillofacialsurgery department Surgical healing Factors
affecting the wound healing Local factors:
1- poor blood supply. 2- hematoma. 3- infection. 4- tension in the
wound. 5- bad surgical technique. 6- foreign body. Mosul
university- College of dentistry-oral & maxillofacialsurgery
department Treatment of wounds 1- primary suturing: done for clean
wound
2- delayed primary suturing: done if the wound is lacerated or
heavy infected. 3- secondary suturing: if we had done primary
suturing & infection developed pus under skin so need open
& frequent dressing then resuturing. 4- skin graft : big wound
& impossible to reapproximate the wound edges, so it is
important to cover the denuded area to prevent bacterial infection
& fluid loss. Mosul university- College of dentistry-oral &
maxillofacialsurgery department scar Scar : is a remnant of wound
healing Stages of scar
Stage 1- (1-4wks)scar is fine, soft, weak. Stage 2- (4-12wks) red,
thick, strong, contracted, raised above the level of skin, itching.
Stage 3- (12-40wks) white soft, tend to relax. After 1-2 years very
fine not obvious scar Mosul university- College of dentistry-oral
& maxillofacialsurgery department scar Factors affecting
scar:
1- age best in extreme age worse in children. 2- race: better in
white worse in dark skinned 3- position in the body: face good,
sternum bad 4- direction of the wound: if parallel to skin creases
minimal scar. Mosul university- College of dentistry-oral &
maxillofacialsurgery department scar Complications of scar: 1-
excessive contracture deformity.
2- may adhere to nerve neuroma. 3- keliod. 4- hypertrophic scar. 5-
unstable scar 6- malignant changes epitheloma scar Mosul
university- College of dentistry-oral & maxillofacialsurgery
department scar Hypertrophic scar: there is excessive fibrous
tissue formation in young people specially after burn, if stage 2
persists more than 6 months, Hypertrophic scar will happened.
Avoided by pressure bandage which flattens the scar. Mosul
university- College of dentistry-oral & maxillofacialsurgery
department scar Keloid scar: it is a persistent of Hypertrophic
scar more than one year extending to the neighboring skin , the
best treatment are radiation, steroid injection, shaving with skin
graft. Mosul university- College of dentistry-oral &
maxillofacialsurgery department Quiz What are the differences
between Thrombophlebitis and Phlebothrombosis ? Mosul university-
College of dentistry-oral & maxillofacialsurgery department