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DEFINITION
A wound is a break in the continuity of soft tissues A wound is defined as a separation or discontinuity of the skin, mucous membrane or tissue caused by physical, chemical or biological insult
CLASSIFICATION
Open wound
There is discontinuity in the skin and other covering tissues to a varying depth
Classification
Incised wound
Caused by sharp cutting instruments. Minimum loss to tissue tends to gap (the extent of gaping depends upon elasticity and tension). Edges are regular. Bleeds freely and painful. Heals by primary intension healing.
Lacerated wound Caused by tearing of tissues, Wounds have irregular jagged borders Loss of tissue is limited to skin and s/c tissue.
eg: barbed wire. Penetrated wound Cause by sharp pointed objects like nails Have relatively small opening. May be very deep. Infection/ foreign particles might have been carried deep in to wound opening is inadequate for drainage. eg: punctured wound on foot due to gathered nail.
Perforating wound Have two opening one of entrance and other of exit. Punctured wound
Deep wounds communicating with cavities like adbominal, throrax,joints etc. eg: stab wounds
In closed or internal wound only deeper tissues, barring the skin or mucous membrane are damaged.
Classification
1. Contusion or Bruises Produced by blunt objects
Results in damage to subcutaneous tissue without breaking the continuity of the skin surface. Classified into 1st, 2nd and 3rd damages according to the extent or severity of the injury. .
Mild degree of contusion characterized by rapture of capillaries in skin giving rise to a reddish blue or purplish condition of the skin (Echymosis). First degree: There is rapture of capillaries of the skin and subcutaneous tissue to form echymosis. Second degree: Larger vessels are raptured leading to the formation of haemetoma. Third degree: Tissues are considerdly damaged and gangrene may set in. the internal organs which may also be impaired and there might be evidence of impending shock.
2. Haematoma:
Collection of blood beneath the skin Caused by injury to a superficial vein. Frequently seen s/c or submucosally. Common sites of haematoma in various species
Cow: mammary vein(fall) vaginal mucous membrane (copulation) Bull: haematoma involving penis (copulation) Horse: spur vein / external thoracic vein Dog: ear flap, vaginal mucous membrane (copulation)
Symptoms
Local
General Remote
Local Symptoms
Hemorrhage
Pain Gaping of the edges of wound Phenomena of repair
General Symptoms
Febrile disturbances
Remote Symptoms
Observed away from the wound
Abscess formation in a dependent lymph node Paralysis or a loss of function in a dependent portion Neuritis extending along the course of the nerve involved in the wound.
Management of wounds
Contusions: are treated with cold and astringent applications to minimize extravasation.
Haematomas: when small get absorbed ,other wise they may have to be opened and treated. Open wound: surgical or aseptic wound/ contaminated and septic wound/ accidental traumatic wounds.
Suture should be supported up to healing time 8 -14 days Systemic use of specific antibiotics as a therapeutic or prophylactic measure. Local application of Fly repellents hot summer months. The patient and the affected injured part should be kept at rest
General principle
Control of haemorrhage: Bleeding is controlled and
ligating large vessels if any
Wound and its periphery should be thoroughly cleaned with warm normal saline, water, soap or 2% H2O2 5% dettol, 0.5% potassium permanganate
Clipping and shaving of large area around wound
Wound debridement
Debridement for removal of devitalized or necrosed tissue is either done by excising the unhealthy tissue or by use of topical mendicaments
Control of infection
Providing drainage
If there is exudation and discharge the wound should not be sutured.
Deep wounds fenestrated tube is advisable for drainage Deep wounds with narrow external opening may be enlarged for efficient drainage.
Counter opening may be made in a dependent part seton may be passed through it.
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A wound is defined as a separation or discontinuity of the skin, mucous membrane or tissue caused by physical, chemical or biological insult.
Wound healing is restoration of the tissue continuity
Wound Healing
First intension Second intension Mixed intension Third intension Healing under scab
Wound should be clean and fresh Free form infection and bleeding Free from foreign bodies Edges should have good blood supply
When granulation is complete the scab automatically separates and is cast off
Exudate provides fibrinogen and other clotting elements, which form fribin clots These clots plugs the damaged lymphatics, preventing further damage from injured area Inflammatory reaction is thus localized to a specific area surrounding the injury Redness, swelling and heat are seen during inflammatory reaction in the area
[B] Fibroblastic or Collagen phase: Begins at about 5th day Fibroblast are actively engaged in production of connective tissue matrix Fibrinogen in exudate is converted to fibrin by enzymes from blood and tissue cells
Fibrin is laid down in the wound and provides a good frame work for repair besides haemostasis Collagen is synthesized by the fibroblasts
Few collagen fibers are present at the beginning but by 15th day wound gets good tensile strength Sutures are therefore removed about 2 weeks of surgery
[C] Maturation phase: It starts after collagen bed is laid Collagen fibers become thicker, denser and number of fibroblast decreases Pale scar is formed, full maturation of scar may take months or year
[D] Contraction phase: It involves movement of existing tissue at the wound edges resulting decrease in size of open wound Absence of attachment of the skin to the underlying structures allow maximal contraction Contraction has been reported to be a cell mediated phenomenon
Contractions near joints may result in the formation of tight band of scar tissue
SYSTEMIC FACTORS: Age Obesity Malnutrition Vitamin deficiancy Anaemia and hypoxia Systemic disease Temperature
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