Infected wounds are always an unpleasant surprise. By itself, a violation of the integrity of the skin does not pose a danger to humans, but if the bacterial flora joins this, the inflammatory process begins, accompanied by an increase in local temperature, redness, pain and impaired function of the limb and / or organ on which the wound is located.
Definition
A wound is a violation of the integrity of the skin or mucous membranes in a mechanical way. Damage to underlying tissues and aggravation of a traumatic condition are possible. This is a type of injury that always poses a threat to human life and health. It is an essential aspect of study in surgery.
Injury is a traumatic situation that leads to a wound.
Clinic
The symptoms that accompany infected wounds depend on their number and severity of the condition. There are several local signs inherent in any injury of this kind.
- Pain. At the moment when the integrity of the skin is violated, nerve endings are damaged, and a significant amount of cytokines and prostaglandins are released, which stimulate unpleasant sensations. The sensitivity of tissues in different parts of the body is not the same. It is most pronounced near the nerve trunks, at the periosteum, in the pulp of the tooth, in the peritoneum and pleura. Parenchymal organs, like the brain, do not have pain receptors.
- The gaping of the wound depends on its width and depth, as well as on the number of torn fibers. The largest is observed with damage to muscles and a significant fat layer.
- Bleeding. This symptom is closely related to the site of injury. If large vessels, especially arteries, are damaged, then blood loss will be significant, but rupture of capillaries will not cause significant damage to health.
If a superficial wound is inflicted, then the general reaction of the body will be insignificant. But with multiple deep cut wounds, the symptoms will be due to the location of the injuries, the degree of blood loss and the attachment of a secondary infection. It is dangerous for the development of hemorrhagic or hypovolemic shock, cerebral hypoxia, sepsis and other complications.
Wound Classification
For doctors, there is a single directory of diseases in which an infected wound is also listed. ICD 10 assigned her the code T80-T88. This section is responsible for human injuries and their complications. But there is another classification.
For example, by the nature of weapons, a gunshot wound and a knife wound are distinguished.
By the cutting edge of the traumatic agent, one can distinguish such species as: chipped, chopped, chopped, torn, bitten, bruised, crushed, and so on.
According to the shape of the defect, linear, patchwork, hole damage is noted.
According to the depth of penetration of the traumatic agent, surface, penetrating, penetrating and tangential wounds are distinguished.
There is even a classification indicating the extent to which an infected wound is divided (ICD 10 does not highlight this):
- aseptic (after the initial surgical treatment);
- contaminated (there are microbial bodies, but there are no signs of inflammation yet);
- infected (there is redness, swelling, local temperature increase, pain and a change in function).
Wound healing depends on what it caused. There are three scenarios:
- primary tension (the wound is clean, not deep, applied with a sharp object);
- secondary tension (a large number of granulations, infected wounds);
- healing under a scab (coagulation necrosis from a chemical burn).
Wound process
The wound process is the sequential changes that occur in the wound in the process of its receipt and healing, as well as the reactions of the body caused by this process. They are aimed at delimiting the focus of infection from the vasculature and removing all pathological agents from it. The universal way that nature came up with in order to protect a person from the effects of injuries is an inflammatory reaction.
The first phase of the wound process is based on the physical reaction of tissues to injury. Immediately after the wound, the death of some tissues, their bruise and cavitation, as well as the formation of hematomas are observed. In the first seconds, a vascular spasm occurs, which is replaced by a sharp expansion of blood vessels and bleeding. After a short period of time, blood flow slows down and a blood clot forms. In parallel , inflammatory mediators accumulate in the wound , which attract white blood cells, phagocytes and mast cells. Bacteria accidentally introduced onto the wound surface are eliminated and absorbed by local cellular immunity.
Some time later, an inflammatory shaft of dead cells and edema appear around the wound. The vascular network is compressed, secondary necrosis is formed. It is at this moment that pain appears and the function of the affected area is impaired.
The second phase of the wound healing process begins in three days, but a clear boundary does not exist. The inflammatory process continues, and an infected wound is obtained from a soft tissue injury. The ICD code changes by a few points. Mechanical wound cleansing stimulates the growth of granulation tissue, and the removal of dead bacteria by phagocytes reduces inflammation. The regeneration process begins, new blood vessels form, dense collagen tissue grows, and a fresh soft scar appears on the site of the wound.
Ten to fourteen days later, the third phase begins - scarring and epithelization. Collagen threads are becoming more dense, blood vessels no longer sprout. At the same time, a layer of the epidermis is formed. The new scar has a pale pink color, but over time, the capillaries disappear and it turns pale, becoming almost invisible.
According to this scheme, everyone heals, not just infected wounds. Of course, individual variations of these three phases are always present.
Body response to an infected wound
The general reaction can be divided into catabolic and anabolic phases. During the first (until the 4th day), all vital processes intensify: the temperature rises, the metabolism accelerates, a person loses weight, protein synthesis is inhibited and the permeability of cell membranes is reduced. The body tunes in for regeneration.
The second phase begins on the fourth day after the injury, and everything gradually falls into place. Body weight is restored to its previous level, metabolism is normalized, and with it the temperature drops. The activity of adrenal hormones is slightly increased.
Wound healing
Each tissue has a certain tendency to regenerate. Not all cells produce similar ones equally well, especially if it is an infected wound (ICD does not give any recommendations in this regard). The speed and quality of healing depends on the conditions in the affected area. If it is dry, clean and there are no foreign bodies or bacteria, then the process will proceed faster. And, accordingly, vice versa. The general condition of the body also affects the rate of regeneration. In young and healthy people, healing is easier, but the presence of chronic diseases, large blood loss or vitamin deficiency can aggravate the course of the disease and delay the recovery process for several weeks, or even months.
Surgical treatment of wounds
The purpose of the primary surgical treatment is the mechanical cleaning of the wound from necrotic tissues, foreign bodies and bacteria. Treatment of infected wounds begins with the fact that the skin around the damaged area is wiped with a cotton or gauze swab dipped in alcohol / saline, and then treated with a one percent solution of iodine. The surgical field is covered with sterile wipes, and after anesthesia, the edges of the wound are pushed apart and spread apart. This is to make it easier to remove foreign bodies and dirt. For example, if a patient has an infected foot wound, then most likely there are particles of earth in it.
Necrotic tissue excised. If necessary, the wound can be enlarged for better access to all blind places and possible pockets. If there are damaged large vessels, then they are bandaged, and the nerves are sutured. After the surgeon has finished removing everything unnecessary, the wound is sutured tightly and an aseptic dressing is applied. Some exceptions are mentioned in the ICD. An infected foot wound, for example, should remain open, because anaerobic bacteria that cause rotting live in the soil with which it was contaminated. Yawning damage provides constant access of oxygen to tissues, which means that it does not allow microorganisms to develop.
Purulent Wound Therapy
Clinical signs by which it can be determined that in a person, for example, an infected wound of the lower leg, appear on the second or third day from the moment of injury. This is facilitated by the presence of signs of inflammation and pathogenic or conditionally pathogenic flora. In the treatment of such injuries, one should focus on the type of bacteria and select an antibiotic that is appropriate for sensitivity. The general approach is as follows:
- full wound cleansing;
- antiseptic treatment;
- staging of drainage for better outflow of infected fluid;
- stimulation of the local immune system.
General treatment
Antibiotics remain the cornerstone in the treatment of infected wounds. The drug, route of administration, dose and frequency of administration directly depend on the microorganism that caused suppuration. If the flora is anaerobic, then it is best affected by metronidazole and clandomycin in combination with sulfonamides.
Impaired immune function, both local and general, is reflected in the healing process, so it is necessary to maintain it at the right level. Mobilization of protective factors of the body helps to avoid complications such as sepsis, fever and others.