A wound is mechanical damage to tissues in the presence of violations of the integrity of the skin. The presence of a wound, and not a bruise or hematoma, can be determined by such signs as pain, gaping, bleeding, impaired function and integrity. PHO wounds are carried out in the first 72 hours after injury, if there are no contraindications.
Varieties of wounds
Each wound has a cavity, walls and a bottom. Depending on the nature of the damage, all wounds are divided into punctured, cut, chopped, bruised, bitten and poisoned. During the conduct of PHO wounds, this must be taken into account. After all, the characteristics of first aid depend on the nature of the injury.
- Puncture wounds are always inflicted with a pricking item, such as a needle. A distinctive feature of the damage is a large depth, but small damage to the integument. In view of this, you must make sure that there are no damage to blood vessels, organs or nerves. Puncture wounds are dangerous due to mild symptoms. So if there is a wound on the abdomen, there is a chance of liver damage. This is not always easy to notice when conducting a PCF.
- A cut wound is applied with a sharp object, so tissue damage is small. At the same time, the gaping cavity is easy to inspect and perform. Such wounds are well treated, and healing is carried out quickly, without complications.
- Chopped wounds appear due to damage with a sharp but heavy object, such as an ax. In this case, the lesions differ in depth, the presence of wide gaping and bruising of adjacent tissues is characteristic. Because of this, the ability to regenerate is reduced.
- Bruised wounds appear when using a blunt object. These lesions are characterized by the presence of many damaged tissues that are heavily saturated with blood. When conducting PHO wounds, it should be borne in mind that there is a possibility of suppuration.
- Bite wounds are dangerous by infection with the saliva of an animal, and sometimes a person. There is a risk of developing an acute infection and the appearance of the rabies virus.
- Poisoned wounds usually occur when there is a snake or spider bite.
- Gunshot wounds vary in the type of weapon used, the characteristics of the damage and the paths of penetration. The probability of infection is high.
When conducting PHO wounds, the presence of suppuration plays an important role. Such injuries are purulent, freshly infected and aseptic.
The purpose of the PHC
Primary surgical treatment is necessary to remove harmful microorganisms that have fallen into the wound. For this, all damaged dead tissue, as well as blood clots, are cut off. After this, sutures are applied and drainage is performed, if necessary.
The procedure is necessary in the presence of damage to tissues with uneven edges. Deep and contaminated wounds require this. The presence of damage to large blood vessels, and sometimes bones and nerves, also requires surgery. PECs are carried out simultaneously and exhaustively. The help of the surgeon is necessary for the patient for up to 72 hours after applying the wound. Early PHC is carried out during the first day, conducting on the second day is a delayed surgical intervention.
Tools for Pho
The initial wound treatment procedure requires at least two copies of the kit. They are changed during the operation, and after the dirty stage, they are disposed of:
- clamp "Korzang" straight, which processes the surgical field;
- scalpel pointed, abdominal;
- linen slippers are used to hold dressings and other materials;
- clamps of Kocher, Billroth and "mosquito" are used to stop bleeding, while conducting PHO wounds they are used in large quantities;
- scissors, they are straight, as well as curved along a plane or rib in several instances;
- Kocher probes, grooved and bell-shaped;
- set of needles;
- needle holder;
- tweezers;
- hooks (several pairs).
The surgical kit for this procedure also includes suture material, injection needles, syringes, bandages, gauze balls, rubber gloves, all kinds of tubes and wipes. All items that will be needed to conduct PHO - suture and dressing sets, tools and medicines intended for treating wounds - are laid out on the surgical table.
Essential Medicines
Primary surgical treatment of a wound does not do without special medicines. Most commonly used are:
- 70% alcohol;
- 3% hydrogen peroxide solution;
- 1% solution of iodopyron or 0.5% solution of chlorhexidine bigluconate;
- 10% NaCl solution;
- 0.25% - 0.5% solution of novocaine.
STP stages
Primary surgical treatment is carried out in several stages:
- Inspection of the wound with its subsequent treatment with an antiseptic.
- Removal of damaged tissue, foreign bodies, bone fragments. Wound dissection is performed as necessary.
- Stop bleeding.
- Drainage.
- Suturing.
How is the PHo done
For surgery, the patient is placed on the table. Its position depends on the location of the wound. The surgeon should be comfortable. A wound toilet is being carried out, the surgical field is being treated, which is delimited by sterile disposable linen. Next, primary tension is performed, aimed at healing existing wounds and anesthesia is administered. In most cases, surgeons use the Vishnevsky method - they inject a 0.5% solution of novocaine at a distance of two centimeters from the edge of the cut. The same amount of solution is introduced on the other hand. If the patient responds correctly, a lemon peel is observed on the skin around the wound. Gunshot wounds often require the introduction of general anesthesia to the patient.
The edges of the damage up to 1 cm are held by the Kocher clamp and are cut off in a single block. During the procedure, non-viable tissue is cut off on the face or fingers, after which a tight suture is applied. Gloves and used tools are being replaced.
The wound is washed with chlorhexidine and is examined. Puncture wounds with small but deep incisions are dissected. If the edges of the muscles are damaged, they are removed. Do the same with bone fragments. Next, hemostasis is performed. The inside of the wound is treated first with a solution, and then with antiseptic drugs.
The treated wound without signs of sepsis is sutured tightly with the primary manual suture and covered with an aseptic dressing. Seams are performed uniformly capturing all layers in width and depth. It is necessary that they touch each other, but not pull together. When performing work, it is necessary to obtain a cosmetic suture after healing.
In some cases, the primary seams are not overlapping. A cut wound can have more serious damage than it seems at first glance. If in doubt, the surgeon will use a primary delayed suture. This method is used if the wound has been infected. Suturing is carried out to fatty tissue, and the seams are not tightened. A few days after the observation, the wound is sutured to the end.
Bite wounds
PHO of a wound, bitten or poisoned, has its own differences. With bites of non-toxic animals, the probability of contracting rabies is high. At an early stage, the disease is suppressed by rabies serum. Such wounds in most cases become purulent, so they try to delay PHE. When performing the procedure, a primary-delayed suture is applied and antiseptic drugs are used.
A wound from a snakebite requires the application of a tight tourniquet or bandage. In addition, the wound is frozen with novocaine or cold is applied. Anti-snake serum is introduced to neutralize the poison. Spider bites are blocked by potassium permanganate. Before that, the poison is squeezed out, and the wound is treated with an antiseptic.
Complications
Poor treatment of the wound with antiseptics leads to suppuration of the wound. An improper painkiller, as well as causing additional injuries, causes the patient anxiety due to the presence of pain.
Rude attitude to tissues, poor knowledge of anatomy leads to damage to large vessels, internal organs and nerve endings. Insufficient hemostasis causes the appearance of inflammatory processes.
It is very important that the primary surgical treatment of the wound was performed by a specialist in accordance with all the rules.