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Taking Care of Wounds
Wounds of all sizes and severity should always be handled carefully. In this guide, we will discuss these different types of injuries and what to look for during wound care. Care for wounds and lacerations enables the body to heal faster, reduce the risk of infection as well as improve the physiology of area of area.
The healing process begins immediately after the injury by coagulation and migration of leukocytes. Neutrophils and macrophages remove cellular debris (e.g., B. necrotic tissue) and bacteria. Macrophages also stimulate fibroblast production and neovascularization. The fibroblasts emit collagen. In order to start, you generally within the first 48 hours with a maximum of 7 days. The collagen production is largely complete after one month but will strengthen the collagen fibers slowly than their networking.
The Healing and Recovery of a Wound
The durability of the wound area reached after three weeks only 20% of its maximum, after four weeks 60% and the maximum even after one year. Epithelial cells migrate from the edge of the wound immediately after the injury in the wound. In a surgically supplied wound (primary wound healing) to form for 12-24 hours, effective protection against water and bacteria and the same after five days again the normal epidermis. In a non-sealed wound (secondary wound healing) epithelialization takes longer depending on the size of the defect.
Due to the natural elasticity and the underlying muscles forces acting on the skin (skin Representative minimum voltage lines). Because the scar tissue is not as healthy as the surrounding undamaged tissue, these forces tend to draw a scar in width, which can lead to a cosmetically unacceptable image after a seemingly reasonable wound closure times.
Scar growth is particularly common when the forces acting perpendicular to the wound edge. This tendency (and the stress on the wound) can be observed already in the fresh wound. Gaping wound margins speak for a vertical voltage relatively close abutting edges of the injury for lateral forces. Representative minimal skin tension lines, the train takes place in the direction of each skin line. So cuts perpendicular to these lines are under the most significant stress and tend most likely to prosper. The scar tends about eight weeks to redness and grandeur. When the collagen formation begins, the injury is thinner, and the redness decreases. In some patients, however, the scar hypertrophy and it is unsightly and prominent. Keloids are excessive scars that extend beyond the borders of the original wound. Among the most common factors that interfere with wound healing, tissue ischemia includes infection or both.
Factors affecting wound healing);
Tissue ischemia ( restricted blood supply) predisposes to infections. The lower extremities are most usually affected by poor healing by circulatory disorders. In the scalp and the face is the lowest risk. Certain medications and diseases can also impair wound healing.
Bite wounds are heavily contaminated generally. Factors that affect wound healing factor Examples tissue ischemia ((due to features of the wound or because of local circulatory disorders) disorders that affect the peripheral vessels (e.g., As diabetes, arterial insufficiency) type of injury such. Like a bruise, the microcirculation destroyed) Repraturtechniken (z. B. much too narrow seams) the use of cautery. Bacterial proliferation wound hematoma foreign body (including subcutaneous sutures) Delayed treatment (e.g., B.> 6 h with injuries to the lower extremities the;> 12-24 h at facial and scalp injuries) Significant wound contamination (such. B. Drug ) therapy antiplatelet agents and anticoagulants drugs that suppress inflammation (eg. Corticosteroids, immunosuppressants) Certain diseases that contain the immune system disease, or healing effect (eg. As chronic kidney disease) Malnutrition (z. B. . protein-calorie malnutrition, deficiencies of specific nutrients such as vitamin C) disorders of collagen synthesis (eg. as Marfan syndrome, Ehlers-Danlos syndrome) Rating Among the various steps in the evaluation include the following: finding and treating severe injury blood silent.
After looking damage to the underlying layers, A doctor will first look for your serious injuries and treat them before it is critical to skin wounds, how significant they also seem to be, Acute bleeding wounds must be satisfied before the examination. Disconnecting bleeding vessels is to be avoided because of the risk of damage to adjacent nerves. This is best completed by adding direct pressure and, if possible, to the high camps. The use of local anesthetics with epinephrine may also help stop bleeding. Careful and temporary placement of a proximal tourniquet can improve visualization of hand and finger injuries.
For an evaluating the wound, it’s essential to have good lighting l. An increase (e.g., As with magnifying glasses) can help, especially if the examiner does not have good near vision has. A full assessment of the wound may require a tissue sample or manipulation and thus local anesthesia. However, implementing a sensory test should precede the administration of a local anesthetic. Associated injuries The wound is inspected for damage to the underlying structures, incl. Nerves, tendons, blood vessels, bones, and joints. In this case, also to possible foreign bodies or perforated body cavities (z. B. peritoneum, thorax) respected. The oversight of these complications is one of the most serious errors in wound treatment. Nerve damage is presumed when the wound distal sensory and motor abnormality is seen.
The suspicion increases if the wound is near major nerves. On examination, the sensitivity is tested for light touch and motor skills. The two-point evaluation is helpful in hand and finger injuries. Here, the examiner touches the skin.
A tendon injury is possible with an injury to the tendon course. A complete tendon transaction leads to a permanent deformation because the forces of the antagonists remain (z. B. drooping foot at Achilles injury, loss of normal finger flexion in violation of the flexor tendons) without counterweight. They may be seen only through pain or relative weakness in the force testing or is discovered during the examination of the wound.
The injured area should be examined by moving in all directions; the injured tendon can withdraw sometimes making it during the inspection of the wound is not visible when the injured site in the rest position. Vascular injury is likely distal to the injury in pallor, reduced or possibly delayed pulse Rekapillarisierung (in each case in comparison with the opposite side). Vascular injury is suspected occasionally in the absence of ischemia when an injury is above a large artery and is deep or complex or caused by a punctured trauma.
Other signs of vascular injury may be a fast-growing or pulsating mass or a sound. A bone injury is possible, especially after blunt trauma (e.g., As stab wound, bite wound), or if the injury took place over a bony prominence. In view of the mechanism or of the injury a radiograph can be done to rule out a fracture. Foreign objects can sometimes be found in wounds, depending on the injury course.
For injuries with glass, debris is very likely during heavy metal rare. For all other substances, there is a moderate risk for foreign objects. If a patient complains of a foreign body sensation, this should not be ignored. Our own sense of the patient is often amazingly accurate. Symptoms of localized pain and area tenderness in a severe wound is also a critical indicator, particularly if the pain in active or passive movement become stronger. An examination of the damage cannot detect very small foreign body unless the wound is superficial and visible in its full depth. Tips and risks complaints about debris feelings of patients should be taken seriously. This feeling is often acutely accurate. A joint penetration should be suspected if the wounds near a joint are profound and have come through a penetrating trauma materialize.
Any penetration of the abdominal or thoracic cavity should be considered in any corresponding localized wound, whose reason is not clearly visible. A wound should not be blindly explored because it brings no reliable results but may cause further damage. In suspicious thorax injuries, an X-ray is performed first, with repetition after 4-6 hours of observation. During this time, a slowly developing pneumothorax should be recognizable. For abdominal wounds, a local anesthetic facilitating the investigation of the wound (the wound may, if necessary, be extended horizontally).
To identify a Hämatoperitoneums, a CT is sometimes made. Patients with a penetration of the fascia should be observed in the hospital. Ultrasound at the bedside can also help to detect injuries such as pneumothorax, hemothorax or hemoperitoneum, especially in unstable patients who are not transported to the CT scan.
Cleaning the Wound of Debris
Imaging techniques are especially recommended when the glass is involved injury or the impact of debris on the wound. If there is a foreign body is suspected or if it is not possible to examine the wound in its entire extent, having imagery testing would be needed to make sure that no debris is still in the wound. Involvement of glass or inorganic materials (. Eg stones, metal fragments) is carried out an X-ray; even broken glass in a size of 1 mm can be seen still. However, organic materials (e.g., as wood chips, plastic) are hardly detected (although their boundaries are recognizable by the displacement of normal structures) on radiographs. Various other methods, including ultrasound, CT and MRI were tried, but none of them is sensitive enough.
A CT scan still offers the best balance of precision and practicality. It is always wise to suspect a foreign body and to explore all wounds with appropriate care. Therapy Treatment includes cleaning and local anesthesia (the order may vary) investigation debridement wound closure The tissue should be treated as gently as possible. Cleaning lacerations Both the wound and the surrounding skin to be cleaned. The subepidermal tissue in the wound is very sensitive and should not aggressive substances (e.g., As povidone-iodine, chlorhexidine, hydrogen peroxide), and vigorous rubbing be suspended. For wound cleaning, it is not necessary to remove hair from the wound edge but makes it easier especially in hair-rich regions (e.g., As scalp) work. If necessary, the hair can be cut off with electric razors or scissors. But they should not be shaved because it microtrauma are generated are the portals of entry for pathogens and increase the risk of infection.
If the wound is in the hair region, the hair should be cut before wound irrigation, so that spillage of in the wound-cropped hair is rinsed. The eyebrows are never cut because the skin-hair boundary is needed for the proper adaptation of the wound edges. Additionally, the eyebrows can ugly or not regrow. Although the wound cleansing is not particularly painful, a local anesthetic is usually applied first, except for heavily contaminated wounds. Here are rinsed best with tap water and a mild soap before the local anesthetic is used. Tap water is clean and free of common wound bacteria and does not increase in this application the risk of infection. Then the wound is cleaned with a harder liquid jet and at times wiped with a fine-pored sponge.Brush and rough materials should not be used.\
Cleansing of the Wound
A corresponding water jet can be produced with a 20-gauge needle or intravenous catheter with a 20-, 35-, or 50-ml syringe; Devices commercially available with built-in splash guard can be helpful. Sterile isotonic saline solution is a suitable detergent. Special surfactant rinse solutions are expensive and of dubious value added. If bacterial contamination is at the center (z. B. bite wound, old wound, cell detritus) may dilute povidone-iodine solution to be effective with an isotonic saline solution in the ratio 1:10, which is safe in this concentration for the fabric. The required volume is different. The debris removal is continued until the visible dirt is removed, and at least 100-300 ml were applied (for larger wounds correspondingly more). The Brush, the skin with a mixture of chlorhexidine and alcohol, can deplete the skin flora before the seam, but it must not get into the wound. How to clean wounds, performing debridement and connects wounds.
Local anesthesia for treatment of lacerations Generally used injectable local anesthetics. Local anesthetics are as topical skin adhesives are used to close wounds in certain cases be advantageous, especially for wounds on the face and scalp and. Lidocaine is often 0.5%, 1% and 2% or bupivacaine for injection 0.25% and 0.5% is used, both of which belong to the local anesthetics of the amide type. For Estertyp include procaine, tetracaine, and Benzocaine.
Lidocaine is used frequently; bupivacaine has a slightly slower onset of action (almost immediately over a few minutes) and a significantly longer duration of action (2-4 h over 30-60 min). The action time can be obtained by addition of the vasoconstrictor epinephrine 1: 100,000 to be extended to both. Because vasoconstriction vascularity of the wound (and defenses) can affect, epinephrine is used mainly for wounds in well-vascularized areas (e.g., As the face, scalp). Although it was the traditional doctrine, epinephrine in distal areas (e.g., As nose, ears, fingers, penis) not to use in order to avoid ischemia of the tissue are complications when used in these areas, rare, and such use is now considered safe.
Epinephrine may be particularly helpful in stopping bleeding from wounds that gush heavily. The maximum dose for lidocaine is 3-5 mg / kg (1% solution = 1 g / 100 ml = 10 mg / ml) for Bupivacaine 2.5 mg / kg. Upon addition of epinephrine, the allowable dose for lidocaine rises to 7 mg/kg and bupivacaine at 3.5 mg/kg. As a side effect of local anesthesia may cause an allergic reaction to occur (urticaria, sometimes anaphylaxis) and upon addition of epinephrine also sympathomimetic side effects (e.g., As palpitations, tachycardia).
Allergies to Treatment Materials
A true allergic reaction is rare especially with the substances of the amide group. Many patients report anxiety or vagal reactions. In addition, allergic reactions often go back to the preservative methylparaben, which is in multiple vials of the local anesthetic. If the causative agent has been identified, a substance should be selected from a different group (e.g., B. from Estergruppe instead of the amide group).
Otherwise, a preservative-free test dose of lidocaine (0.1 ml as a single dose ampoule) may be administered intradermally. If it has been shown within 30 minutes no reaction, the substance can be used. Measures for the relief of pain linked with injections are: using a small needle (a 27-gauge needle is best, and a 25-gauge is acceptable, but a 30-gauge may be too thin) Slow injection Subcutaneous injection instead of intradermal injection buffering lidocaine with 1 ml NaHCO3 (concentration 4.2 to 7.4%) for each 9-10 ml lidocaine solution (Note: buffers reduces the durability of multiple doses, and it is less suitable for Bupivacaine).
Warming of the anesthetic to body temperature. Regional nerve blocks are sometimes preferred for injection into the wound. Nerve blocks cause less distortion of the wound edges by injected anesthetic; this reduced distortion is important when the alignment of the wound edges (z. B. infraorbital nerve block for injuries caused by the vermilion border of the lip) must be especially precise or if the wound injection would be difficult because the space for injection is small (z. B. digital blockade for finger injuries). Anesthetics can anesthetize large areas without the use of toxic doses. Small cons of nerve blocks have a slow onset of anesthesia and sometimes <100% efficacy in the first injection. is like a nerve-Infraorbitalis block performed
The use of topical anesthetics makes an injection superfluous and is completely painless, which is a big advantage for children and anxious adults. The most commonly used solution is LET, consisting of lidocaine 2-4%, Epinephrine 1 is 2000 and 0.5-2% tetracaine: 1000 or the first A dental cotton swab in the length of the wound (or a cotton ball) is soaked in several milliliters of the solution and placed in the wound. After 30 minutes, a sufficient anesthesia is then usually achieved. If an anesthetic on the application of a local anesthetic is not sufficient, another dose can be injected, usually with minimal Schmerzen.Exploration of Platzunden The entire wound is examined to find foreign bodies or a possible hamstring injury. The foreign body can perceive. Also by careful palpation of the tip of a blunt forceps by a characteristic click when they are materials such as glass or metal.
Occasionally, contaminated puncture wounds (e.g., As human bite marks near the metacarpophalangeal joint) need to be strengthened so that they can be adequately explored and cleaned. Deep wounds in the vicinity of a large artery should werden.Débridement examined in the operating room by a surgeon of Platzunden In debriding abrasions scalpel and/or use scissors to the dead tissue and sometimes stuck wound contamination (e.g., As lubricating oil, paint) to remove. Macerated or frayed edges of the wound are excised, usually, with 1-2 mm suffice. Otherwise, the debridement is not used to straighten the edges of the wound. Clear-cut wound edges are sometimes trimmed to make them perpendicular to each would. Closing Wounds and Lacerations – The decision to wound closure depends on the wound depth, the age, the cause, the degree of Ve