Admin
11-13-2009, 01:08 PM
MANAGEMENT OF WOUND
· Rapid evaluation (See resuscitation of the acutely injured patient)
· Resusciation,,
· Review,,
· Radiological and other investigations,,
· Repair:
(A) Clean wound:
- Wash by isotonic sterile saline to remove F.B.
- Devetilized tissues must be exciced.
- All deep structures should be dealt with immediately.
- Close the wound by 1ry suture. It heals by 1st intention
(B) Contaminated wound:
- Wash by antiseptic solution.
- Wound depridment is done. Healthy tissues is left as it is covered by protective layer. Healthy muscle is red and contract when cutting.
- Important blood vessels are dealt with immediately.
- Tendons and nerves are marked and left to be dealt with later on.
- Let the wound open until :
® Become clean ®2ry suture after 5 day."
® Become infected® healed by 2nd intention.
(C) Infected wounds:
1- Open all pockets of pus. 2- Excise all necrotic tissues.
3- Dressing until healing by 2nd intention.
ÄIf the wound became clean, (after dressing):
a- If the defect was small, curette and do 2ry suture.
b- If the defect was wide, do delayed skin graft.
(d) Penetrating wound:
Ä Widening of the wound is done.
Ä Explore deep structures and deal with.
(e) Winnet Orr closed plaster technique:
· Indications: 1- Cases with severe infection of the extremities
2- Infected fractures of the extremities.
· Technique: After good drainage the limb is put in plaster cast which is changed when it become markedly soaked.
· Advantages: 1- Rest promotes healing.
2- Pyogenic membrane will cover the wound protect it from infection.
3- Minimize times of dressing which decrease the possibility of contamination.
· Disadvantage: Bad odour of the soaked wounds.
SOURCE: DR. AYMAN SALEM'S BOOK
Copyright: Vascular Society of Egypt (www.vsegypt.org (http://www.vsegypt.org/)) &Medical Educational web (www.meduweb.com (http://www.meduweb.com/))
Not to be reproduced without permission of Vascular Society of Egypt
· Rapid evaluation (See resuscitation of the acutely injured patient)
· Resusciation,,
· Review,,
· Radiological and other investigations,,
· Repair:
(A) Clean wound:
- Wash by isotonic sterile saline to remove F.B.
- Devetilized tissues must be exciced.
- All deep structures should be dealt with immediately.
- Close the wound by 1ry suture. It heals by 1st intention
(B) Contaminated wound:
- Wash by antiseptic solution.
- Wound depridment is done. Healthy tissues is left as it is covered by protective layer. Healthy muscle is red and contract when cutting.
- Important blood vessels are dealt with immediately.
- Tendons and nerves are marked and left to be dealt with later on.
- Let the wound open until :
® Become clean ®2ry suture after 5 day."
® Become infected® healed by 2nd intention.
(C) Infected wounds:
1- Open all pockets of pus. 2- Excise all necrotic tissues.
3- Dressing until healing by 2nd intention.
ÄIf the wound became clean, (after dressing):
a- If the defect was small, curette and do 2ry suture.
b- If the defect was wide, do delayed skin graft.
(d) Penetrating wound:
Ä Widening of the wound is done.
Ä Explore deep structures and deal with.
(e) Winnet Orr closed plaster technique:
· Indications: 1- Cases with severe infection of the extremities
2- Infected fractures of the extremities.
· Technique: After good drainage the limb is put in plaster cast which is changed when it become markedly soaked.
· Advantages: 1- Rest promotes healing.
2- Pyogenic membrane will cover the wound protect it from infection.
3- Minimize times of dressing which decrease the possibility of contamination.
· Disadvantage: Bad odour of the soaked wounds.
SOURCE: DR. AYMAN SALEM'S BOOK
Copyright: Vascular Society of Egypt (www.vsegypt.org (http://www.vsegypt.org/)) &Medical Educational web (www.meduweb.com (http://www.meduweb.com/))
Not to be reproduced without permission of Vascular Society of Egypt