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Monday, November 26, 2012

Wounds

Definition:
It is the break in the continuity of tissue and sequalae.

Classification of Wounds:
  1. Acute Wounds
  2. Chronic Wounds

Wound


1) Acute Wounds
  • Closed Wounds
  • Open Wounds
Acute Wound
                  
 Closed Wounds

 A) Bruises:
       Whenever there is blunt trauma or fall it will result change in colour of the skin initially bluish then become greenish and black.

Bruises

B) Hematoma:
       It is accumulation of blood in tissues which usually needs evacuation because of pressure symptoms.

Hematoma

Open Wounds
A) Abrasion/ Friction:
       When the skin surface is rubbed off against any surface will result in abrasion.



Abrasion/ Friction
B) Laceration:
       It can be incised (as occurs in surgical blade incision or knife) or penetration wound which occurs in the blunt trauma (with nail or glass).

Laceration


C) Bite Wounds:
       As occurs in dog bite, camel bite etc.

Bite Wound

D) Complex Wounds:
       These includes Crush wounds as occur in Road Traffic Accidents.

 Complex Wound

Injuries to specific tissues
a) Bone b) Muscles c) Nerve d) Blood Vessels e) Fats

Management of Acute Wounds


Closed Wounds Management

 Bruise:
       Bruise usually disappear by itself. It is a self limiting disease. And the clearance time is variable.

Bruise

Hematoma:
       It is usually evacuated.

Hematoma


Open Wounds Management
Lacerated Wounds:
       The dead tissue is removed, if there is an injury to nerves, vessels so they are repaired and wound is closed. patient is given Tetanus Vaccine and Antibiotics.

Lacerated Wound

Bite Wounds:
       Damaged and Necrotic tissue is excised while muscles, nerves and vessels are repaired. In case of rabid animal bite, Rabies Vaccines are given (0, 3, 7, 14, 28th days).


Bite Wound

Abrasion/ Friction:
       Usually there is a skin loss which require skin Grafting.

Abrasion/ Friction

Complex Wounds:
       Usually these wounds do not heal by primary intention. there is odema, exudate and extensive necrotic tissue so the wound is thoroughly cleaned and left open to give time to subside the odema or inflammation. When the wound appear healthy then it is closed. Tetanus Vaccines, Antibiotics and daily dressing are needed.

Complex Wound




2) Chronic Wounds
 A) Ulcers 
B) Pressure sore (Bed sores and Decubitus ulcer)

Chronic Wound
Ulcer
 Definition:
       It is discontinuity in the epithelium and deeper tissues.


Ulcer

Classification of Ulcers:

  • Decubitus Ulcers
          The ulcer occuring due to pressure and ischemia specially of bony prominences (malleolus, sacrum).
Causes/ Risk factors for Decubitus Ulcers:
          Prolong immobility(stroke, paraplegia, orthopedic surgery)
Management:
1) One has to treat the disease and mobilize the patient as soon as possible.
2) Frequent posture change
3) Air cushions are used
4) The decubitus ulcer is kept moist
5)Proper dressing and antibiotics are used
Decubitus Ulcer
  • Tuberculous Ulcers
          Needs anti tuberculous therapy.
Tuberculous Ulcer
  • Syphilic Ulcers
          Needs antibiotic (Benzylpencillin).
Syphilic Ulcer
  • Peptic Ulcers
          Needs antibiotics (Amoxicillin, Clarithromycin, PPI's)

  • Malignant Ulcers
          The common cutaneous ulcers are Squamous and Basal cell carcinoma. These occur on exposed parts. The squamous cell carcinoma Metastasize as well. The treatment is excision, radiotherapy and chemotherapy. One has to find out the cause and it is treated accordingly. 
Malignant Ulcer

  • Neuropathic Ulcers (Diabetes)
          Treat and control the diabetes, for ulcer antibiotics and dressing is done.

  • Haematological Disease (Sickle cell disease, Spherocytosis)
           Children born with sickle-cell disease will require management by a haematologist to assure they remain healthy.
Haematological Disease
  • Venous Ulcers
          Surgery is the option.
Venous Ulcer
  • Arterial Ulcers
          Surgery is the option.
  • Stress Ulcers in Mouth
Stress Ulcer in Mouth
  • Vasculitic Ulcers
Vasculitic Ulcer

                                                                                                                                           



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