Types of wounds and their treatment

 

Incised wounds. A wound inflicted by a sharp instrument and seen within a few hours of inception can be closed as a surgical incision, provided that the wound has not been grossly contaminated with virulent organisms. But it should be remembered that these wounds are always contaminated.

The skin around an incised wound should be treated with antiseptic solution. If the wound is filled with dirt and foreign material, it should be thoroughly rinsed with sterile saline to remove as much contamination as possible. Hydrogen peroxide will sometimes bubble out large amounts of dirt and debris and causes minimal damage to tissue cells. An incised wound that has been contaminated with virulent organisms or has been open for several hours should be packed open and closed several days later when it is certain that infection will not develop.

Lacerated wounds. Lacerated wounds are caused by blunt instruments or by blows which tear the tissues. The edges of lacerated wounds are ragged, and there is more damage to the tissues than in incised wounds. Contamination is usually more marked, and the susceptibility to infection is greater.

Flaps of devitalized skin should be cut away if the blood supply is insufficient and if then sacrifice does not jeopardize closure of the wound. All foreign material should be carefully removed and bleeding controlled. The treatment of lacerated wounds is identical in every respect with that of incised wounds, except that it is often more desirable to pack them open and rely on secondary closure. If the wound becomes infected it is necessary' to defer closure until it is granulating cleanly.

Puncture wounds. Puncture wounds, inflicted by pointed instruments such as a nail, require no surgical treatment unlessimportant structures have been damaged. But it is well to immobilize the part and to use chemotherapy.

In puncture wounds of the foot full doses of sulfadiazine or penicillin should be given for three days, and the patient should use crutches. If he is allowed to walk on the foot, infection will often occur. A tetanus antitoxin should be given. If unfectin occurs, the wound should be opened without delay.

Puncture wounds through the soft tissue of the arm or leg may be treated by immobilization of the extremity and application of a pressure dressing.

Puncture wounds of the chest should be treated conservatively unless the accumulation of blood and air in the pleural cavity causes dyspnea and requires aspiration.

Puncture wounds of the abdomen should be explored if there is any possibility that the peritoneal cavity has been entered. Small puncture wounds of the bowel may produce few immediate symptoms but may result in peritonitis if they are not repaired.

Abrasions. Abrasions, or brush burns, are caused by friction. The epidermis and some of the deeper layers of the skin are lost, and a base is left which is identical with that of a second degree burn. These wounds should be treated as burns, that is to say, washed clean to remove any dirt and covered with a bland ointment or vaseline gauze dressing. A pressure bandage and immobilization will hasten healing. In extensive abrasions chemotherapy is justified. If the wound does not become infected, the dressing should be left in place for ten days, by which time complete epithelization should have occurred. The early removal of dressing is painful and disturbs the new epithelium, which adheres to the dressing.

Avulsion. When pieces of skin and subcutaneous tissue are avulsed the ensuing defect either should be closed by primary suture or should be covered with a skin graft. A split- skin graft will grow on periosteum, tendon sheath, fat, or fascia and should be applied even if the blood supply to the base of the wound is not very promising. Skin is nourished by the lymph and will survive surprisingly well provided that too much contamination is not present

 

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