Basic therms, parametrs, characterics whith are nessesery during preparation to lesson.

Therm	Definition
1. Primiry surgical treatment of wound	This is first intervention of wound which is carried out for the purpose of prevention of development of a wound infection and creating favorable conditions for wound healing.
2. Secondary surgical treatment of wound	This is secondary intervention after primiry surgical treatment of wound

4.2. Theoretical questions for lesson: 1. defined notion “abrasion”“contution”, “wound”. 2. The layerwise structure of soft tissues at different thopographic areas. 3. Blood supply of face. 4. Innervation of face. 5. Classification of wounds. 6. Clinic of damages of soft tossues and bones of maxillofacial area at pease time. 7. The features of diagnostic of traumatic damages of soft tissues of maxillofacial area at pease time. 8. Classification of bleeding. 9. Methods of temporal artherial stop bleeding. 10. Final stop bleeding. 11. What is “primary surgical treatment of wound”. 12. Features of primary surgical treatment of wound. 13. Types of primary surgical treatment of wound. 14. Types of sutures. 15. Methods of temporal immobilization at damages of facial bones.

4.3. Practical skills for lesson: 1. To make digital occlusion of general carotid arthery. 2. To make the mental sling bandage.

5. TABLE OF CONTENTS OF THEME:

 

Open (scratch, wounds)

Complex

Close (contusion)

Isolated

Etiology

Profundity of injury

Type of vulnerary projectile

Penetrating to oral cavity

Deep

Non-gunshot

Lacerated

Bruising

Stab

 

Degloving

Injures of bones at peace time

Contusion

- open; - close; - one-side; - two-side; - direct; - non-direct; - single; - double; - multiple; - line; - comminuted; - with displacement; - without displacement; - traumatical; - pathological.

Bleeding control

Temporary

Continuous

Digital occlusion

Ligation of vessels

application of tourniquet

Vessel-suture

Tamponade

 

 

Clipping in wound

Compressive bandage

Principles of surgical treatment of wound

Early

Single-step

With using of primary plastic

Exhaustive

Radical

PSIHO-EMOTIONAL VIOLATIONS AT DAMAGES OF MAXILLOFACIAL AREA

Psycho-emotional violations which are observed at victims with a trauma of maxillofacial area, are caused by injury of a brain, and emotional reaction to trauma and the related disfiguration of the face.

Mental disorders which arise in connection with an injury of a brain differ considerable polymorphism. They clinical picture depends on localization of damage of brain.

Direct result of injury of a brain are deep frustration of consciousness in the form of a sopor or a coma. The exit from this condition comes not at once. Usually patients are in a condition of devocalization for long time and remind people who finally didn't wake up: they don’t understand at once questions which are raised, long repeat one and a touch the phrase, happen whimsical and whining. Thus patients also complain of a headache, dizziness, noise and weight in the head, nausea; in some cases there is a vomiting. Weakness of storing, fast exhaustion of attention, causeless mood swings are noted. All these phenomena connected with concussion, gradually abate and by the end of the second week usually disappear.

However, in certain cases, after an exit from a coma, there are signs of a delirious condition of consciousness: patients don't remember people around, aren't guided in a situation, don't supervise the behavior. Except disorder of orientation, there are hallucinations, mainly visual, the alarm, fear, develops motive excitement. Contents of hallucinations most often concern the subject closest to the patient: episodes of road incidents, the scenes connected with a profession and so forth. Duration of such condition 2 - 3 days though cases long a delirium after a trauma till 2 weeks.

In some cases sharp traumatic psychosis is characterized by signs of a peculiar twilight condition of consciousness. Into the forefront orientation violation, motive excitement with feeling of fear and unconscious alarm acts. It is promoted by premature transportation. That is why it is important to abstain at a heavy craniocereberal trauma from transportation of patients within 2 - 3 weeks.

That often meet in a wartime - a surdomutizm carry to sharp frustration of the psychological sphere also. This type of pathology is usually connected with an air contusion.

On character of emotional reaction to the received damage of maxillofacial area of victims it is possible to divide into two groups.

In the first group sharpness of reaction isn't proportional to weight of injury of a face that is connected with hypererethism of nervous system.

In the second group mental depression of victims corresponds to extent of functional frustration. Especially heavy frustration cause wounds of the face penetrated into an oral cavity with injury of jaws, tongue, big palate defects, lateral area of the face, a mouth floor and a chin site with a lower lip.

Expressiveness of mental depression depends also on such factors as a profession of the victim, education, the social status and so on.

Psychogenic frustration at patients with injury of a face and jaws proceed differently at different stages of a course of wound process, and are functionally reversible process. It is characteristic that persons who lost sight at wound, don't react at all to a disfiguration, even when absence, for example, a nose or lips is realized and without sight on functional violations.

 At the heavy course of wound process with high temperature and intoxication phenomena, the dream owing to fatigue which interrupts only bandaging, food and oral cavity washings, promotes that mental depression of victims considerably decreases and cases of neurotic reaction arise seldom.

On the contrary, when the general provision of the patient satisfactory, consciousness is kept, intoxication is a little expressed, drowsiness is absent, and he is in chamber where others freely talk, eat not from a poilnik, smoke etc., mental depression and neurotic reaction are observed rather often.

As a whole, in development of psychogenic frustration the next moments matter:

• the mental trauma which has arisen at the time of wound at accurate understanding of the received disfiguration of face;

• mental trauma which the same repeats, at contact with people around, especially at the wrong behavior of the they rather to sick;

• psychotrauma which arises each time when the victim sees his face in a mirror;

• repeated mental trauma in connection with repeated expeditious reconstructive and cosmetic interventions;

• mental trauma in connection with loss of expressiveness of a facial expression or defects of speech (teachers, actors, lecturers, workers of brainwork);

• mental trauma in connection with problems in private life.

Usually at the time of release of the face of the victim from a bandage it has an irresistible desire to look at itself in a mirror. Very often it strengthens neurotic reaction which and without that takes place. At heavy damage, especially if the doctor couldn't prepare the patient or underestimated this moment, the impression can be very negative. The victim starts retiring, becoming reserved, refusing communication with relatives.

In pathogenesis of emotional shifts at a disfiguration of face the consciousness of ugliness becomes the reason of heavy mental depression which can lead to a depression, psychosis and even to suicide.

In some cases neurotic reaction at wounded in a face is possible also as a result of functional or organic changes which result from an injury of a brain. Therefore even in the absence of mental depression wounded in a face differently, not as at wound of other sites of a body, perceive both the condition, and result of treatment.

For prevention of development of serious psycho-emotional conditions the victim needs to provide consultation of the psychiatrist or the psychotherapist in due time. It is desirable to place such wounded in chamber with the victims having similar damages, in every possible way to support in it belief in recovery (psychotherapeutic conversations, communication with the patients who have already transferred recovery operations with satisfactory cosmetic effect, demonstrations of photos on which results of successful plastic surgeries, etc. are fixed). In hard cases it is necessary to provide continuous supervision for wounded or even to transfer it to a psychiatric institution.

6. MATHERIALS FOR SELF-CHECKING: