General surgery

1. Wound and wound
infection
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2.  Wound – is injury with disruption of
skin or mucous membranes and
possible underlying tissues injuries
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3. Classification of wounds
 1. Depending on the cause
 - surgical (aseptic)
 - accidental (casual)
 - battle (wartime)
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4.  2. According to the character:
 - incised (knife, blade)
 - stab (bayonet, awl)
 - chopped (axe, sabre)
 - contused (blunt tools)
 - crushed (blunt tools)
 - lacerated (traction with sharp retractor)
 - bite (animals, human)
 gunshot (wound canal, primary traumatic
necrosis, concussion area)
 - poisoned (spiders, snakes)
 combined
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5.  3. Depending on the presence of infection:
 - aseptic
 - infected
 - purulent
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6.  4. In relation to the bodily cavities:
 - penetrating
 - non-penetrating
 5. Depending on the presence of
complications:
 - non-complicated
 - complicated
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7. Clinical manifestation
 Pain
 Bleeding
 Gaping
 Dysfunctions
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8. Complications of wounds
 Bleeding with hemorrhagic shock
 Injury of vital organs
 Infection
 Longterm consequences (contractures,
organs insufficiency etc)
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9. Healing of the wound:
 by primary intention
 by secondary intention
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10. Wound healing phases:
 Inflammatory phase
 Proliferative phase
 Remodeling phase
 Epithelialization
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11. Inflammatory phase
 In the inflammatory phase, bacteria and are
debris are phagocytosed and removed, and
factors are released that cause the
migration and division of cells involved in the
proliferative phase.
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12. Basic signs of inflammation
 Redness (rubor)
 Swelling (tumor)
 Pain (dolor)
 Increase in local temperature (calor)
 Functions disorder
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13. Proliferative phase
 The proliferative phase is characterized by
angiogenesis, collagen deposition,
granulation tissue formation,
epithelialization, and wound contraction.
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14. Remodeling phase
 In the maturation and remodeling phase,
collagen is remodeled and realigned along
tension lines and cells that are no longer
needed are removed by apoptosis.
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15. Epithelialization
 In epithelialization phase, epithelial
cells migrate across the tissue to form
a barrier between the wound and the
environment.
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16. Factors affecting wound healing
 A. General factors:
– age
– debilitation results in malnutrition
– diabetic patients
– jaundice, uremia
– cytotoxic drugs and malignancy
– generalized infection
– Corticosteroides
 B. Local factors:
– poor blood supply
– local infection
– haematoma
– faulty technique of wound closure
– tension while suturing
– oxygen
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17. First aid
 Haemostasis (temporary or definitive)
 Cleaning of surrounding skin with an
antiseptic solution
 Application of aseptic dressing on the
wound
 Transport immobilization
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18. Primary surgical wound debridement
 Early (within 24 hours)
 Delayed (within 24-48 hours)
 Late (more than 48 hours after injury)
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19. Primary surgical wound debridement
 Main purpose – prophylaxis of wound
infection development
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20. Primary surgical wound debridement
involves:
 Excision of wound edges, bases and walls
up to the intact tissues
 Removing all non-vital tissues, foreign
bodies, clots of blood
 Repair of blood vessels, nerves, muscles
 Suturing the wound
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21. Wound closure
or wound suturing:
 Primary suturing
 Wound excision and primary suturing of skin
 Wound excision and delayed primary suture
 Secondary suturing
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22. Secondary surgical wound
debridement:
 Main purpose – surgical treatment of
purulent wound
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23. Secondary surgical wound
debridement involves:
 Wide long incisions
 Opening all pockets in wound and combined
in one cavity
 Excision all necrotic tissues
 Insertion of drainage tubes, washing
systems for permanent cleaning the wound
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24. Treatment of purulent wounds
 1. In hydration phase:
 - removing pus
 - washing with antiseptic solutions (H2O2,
furacilin, KMnO4)
 - bandages with hypertonic solutions
 - proteolytic enzymes
 - laser, ultrasound cavitation
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25. Treatment of purulent wounds
 2. In dehydration phase
 - ointments with antibiotics
 - ointments with substances, which stimulate
reparative processes in wound (solcoseril,
actovegin, metyluracil)
 - physiotherapy
 - secondary sutures
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26. Thank you for your attention
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