Infected wounds are always an unpleasant surprise. In itself, a violation of the integrity of the skin does not pose a danger to humans, but if the bacterial flora joins this, then an 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 by mechanical means. Possible damage to underlying tissues and aggravation of the traumatic condition. This is one of the types of injury that always poses a threat to human life and he alth. It is the most important aspect of study in surgery.
A wound is a traumatic situation that results in a wound.
Clinic
The symptoms that accompany infected wounds depend on their number and severity of the condition. There are several local signs that are 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,that stimulate discomfort. The sensitivity of tissues in different parts of the body is not the same. It is most pronounced near the nerve trunks, near the periosteum, in the dental pulp, in the peritoneum and pleura. Parenchymal organs, like the brain, do not have pain receptors.
- The gaping of a wound depends on its width and depth, as well as on the number of broken fibers. The greatest is observed with damage to the muscles and a significant fat layer.
- Bleeding. This feature 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 he alth.
If a superficial wound is inflicted, then the overall reaction of the body will be insignificant. But with multiple deep incised wounds, the symptoms will be determined by the location of the injuries, the degree of blood loss and the addition of a secondary infection. This 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, which also includes an infected wound. 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, according to the nature of the weapon, a gunshot wound and a knife wound are distinguished.
According to the cutting edge of the traumatic agent, one can distinguish such types as: chopped, cut, chopped, torn, bitten, bruised, crushed, and so on.
Polinear, patchwork, perforated damage is noted in the form of the resulting defect.
According to the depth of penetration of the traumatic agent, superficial, penetrating, through and tangential wounds are distinguished.
There is even a classification indicating the degrees into which an infected wound is divided (ICD 10 does not highlight this):
- aseptic (after primary surgical treatment);
- contaminated (there are microbial bodies, but there are no signs of inflammation yet);
- infected (redness, swelling, localized fever, pain, and change in function present).
Wound healing depends on how it was applied. There are three scenarios:
- primary intention (the wound is clean, shallow, caused by a sharp object);
- secondary tension (large amount of granulations, infected wounds);
- healing under the scab (coagulative necrosis from chemical burn).
Wound process
The wound process is the successive 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 vascular network and removing all pathological agents from it. The universal way that nature has come up with in order to protect a person from the consequences of injuries is an inflammatory reaction.
The first phase of the wound process is based on the physical response of tissues to injury. Immediately after injurythere is a death of part of the tissues, their bruising and cavitation, as well as the formation of hematomas. 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 with this, inflammatory mediators accumulate in the wound, which attract leukocytes, phagocytes and mast cells. Bacteria accidentally introduced to the wound surface are eliminated and absorbed by local cellular immunity.
Some time later, an inflammatory shaft of dead cells and swelling 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 disturbed.
The second phase of the wound process occurs after three days, but there is no clear boundary. The inflammatory process continues, and an infected wound is obtained from a soft tissue injury. The ICD code changes by several points. Mechanical wound cleansing stimulates the growth of granulation tissue, and removal of dead bacteria by phagocytes reduces inflammation. The process of regeneration begins, new blood vessels are formed, dense collagen tissue grows, and a fresh soft scar appears at the site of the wound.
After ten to fourteen days, the third phase begins - scarring and epithelialization. Collagen threads become more and more dense, the vessels no longer germinate. At the same time, a layer of the epidermis is formed. The new scar has a soft pink color, but over time, the capillaries disappear, and it turns pale, becoming almost invisible.
According to this scheme, everyone heals, not only infected wounds. Of course, there are always individual variations of these three phases.
The reaction of the body to an infected wound
The overall reaction can be roughly divided into catabolic and anabolic phases. During the first (up to the 4th day), all vital processes intensify: the temperature rises, metabolism accelerates, a person loses weight, protein synthesis is inhibited and the permeability of cell membranes decreases. The body is set to regenerate.
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 their own kind equally well, especially if it is an infected wound (the ICD makes no recommendations on this). 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 he althy people, healing is easier, but the presence of chronic diseases, large blood loss or beriberi can aggravate the course of the disease and delay the recovery process for several weeks or even months.
Wound debridement
The purpose of primary surgical treatment is mechanical cleansing 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 1% iodine solution. The surgical field is covered with sterile napkins, and after anesthesia, the edges of the wound are moved apart and parted to the sides. This is necessary in order 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 tissues are excised. If necessary, the wound can be enlarged for better access to all blind spots and possible pockets. If there are damaged large vessels, then they are tied up, and the nerves are sutured. After the surgeon has finished removing all unnecessary, the wound is tightly sutured and an aseptic bandage is applied. Some exceptions are mentioned in the ICD. An infected foot wound, for example, should be left open, because the soil with which it was contaminated is inhabited by anaerobic bacteria that cause decay. The gaping damage provides a constant supply of oxygen to the tissues, which means that it does not allow microorganisms to develop.
Therapy of purulent wounds
Clinical signs that can be used to determine that a person, for example, an infected leg wound, appear on the second or third day from the momentinjury. This is facilitated by the presence of signs of inflammation and pathogenic or opportunistic flora. When treating such lesions, one should focus on the type of bacteria and select an antibiotic that is appropriate for sensitivity. The general approach is:
- complete cleansing of the wound;
- treatment with antiseptics;
- staging drainage for better outflow of infected fluid;
- stimulation of the local immune system.
General treatment
Antibiotics remain a 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.
Violation of the function of immunity, both local and general, affects the healing process, so it is necessary to maintain it at the right level. Mobilization of the body's protective factors helps to avoid complications such as sepsis, fever and others.
