Let's Test Ourself
Wound Care
The wounds may be caused by a large number of objects, all of which can cause different types of damage. Wound treatment is best performed with a systematic approach. Especially children may have difficulty in wound care because they may be scared. 11 questions that will provide a systematic approach to wound care (Table)
Table 1: Questions to be asked about any wound:
1. Is there any combined damage?
2. What and how caused the wound?
3. What type of wound is this?
4. Is there any foreign material?
5. How deep is the wound and what other deep tissue has it landed on?
6. Is it safe to close the wound urgently?
7. How is this wound best closed?
8. Which dressing should be used?
9. Does this site need to be immobilized?
10. Are antibiotics indicated?
11. Does the child have tetanus immunity?
Any combined damage?
1. Is there any life or extremity threatening damage that requires priority?
2. Is there any damage related to the wound (eg arterial bleeding or an underlying fracture)?
If the answer to these questions is no, further treatment of a wound is performed.
What caused the wound and how?
A detailed history is required. Information on the injurious agent and the force applied may affect the treatment. This is especially true for penetrating injuries reaching deep tissues (Figure 1). The possibility of a foreign substance in it should always be considered. It can be extremely difficult to identify any foreign matter remaining in the wound.
Human and animal bites tend to develop infections, especially if they are not recognized early (Figure 2).
Picture 1: A penetrating wound on the left palm. Possible structures at risk include: digital nerves, tendons, tendon leaves and bone.
Picture 2: Dog Bite. The concentric lines reflect the original width of connective tissue inflammation (cellulite) and show progress over time.
What kind of wound is this?
When applying with a wound, the doctor must determine the type of wound. This will help in general wound treatment. The typical classification is:
* Abrasion
* Dents (contusion)
* Torn (laceration)
* Piercing damage
A abrasion occurs as a result of contact with a rough surface and the skin areas are peeled off. Dirt, small stones and dust, which usually enter the skin, make full cleaning difficult without general anesthesia. If these particles are not completely removed, they result in a permanent scarring in the form of a tattoo (Figure 3).
A bruise is caused by contact with a blunt object. Not only the skin is crushed, but the surrounding tissues are bruised, resulting in an additional swelling (Figure 4). This results in a swelling in proportion to the force applied and the affected area.
Tears are defined as simple (Figure 5) and complicated (Figure 6).
Simple wounds are sharp wounds such as knives and razors; they cause surgical type injuries. If the wound is caused by falling onto, for example, a barbed wire or a tree branch, it may be of various shapes and depth. Thus, a wound in the form of dirty, shattered tears can be formed and their treatment can be difficult. To achieve the best results in such complicated wounds, complex plastic surgery is often required.
Perforating injuries are caused by a sharp object puncturing the skin in various thicknesses and in an unknown direction (Figure 7). The problem with penetrating injuries is the unseen portion of the wound which can be unpredictably larger than the visible part of the wound. The foreign material may be buried deep in the wound.
Picture 7: This wound is caused by the child sitting on broken glass. The possibility of remaining glass in the wound and rectal perforation should be considered.
Is there any foreign matter?
The desire to remove the foreign matter should be countered until it is certain that the patient will not be harmed. Not all foreign substances can be seen with X-rays, especially plastic and wood-based objects can be detected by ultrasound techniques (Figure 8,9).
....
Figure 8.9: Swelling above the center of the wound and medial (black mark).
The foreign material was then removed. This wood material, which was not seen on plain X-ray, revealed ultrasound.
How deep is this wound?
In particular, it is difficult to detect tendon and nerve damage in the hand, and a full investigation under general anesthesia and tourniquet control is required. The problem is even greater in abdominal and chest piercing traumas. Radiological evaluation should be used in the decision.
Is it safe to close the wound immediately?
In penetrating injuries and crushes, it may be safer not to close them until the wound is completely cleaned and debrided.
In cases of penetrating injuries, it is likely that the clothing and other particles will drift deep into the wound (Figure 10,11). They are also potential causes for gaseous gangrene.
There is an excessive amount of decay in the dents, which makes the skin relatively sensitive. Edema and swelling also reduce blood flow to the wound, which slows the healing process. The tension caused by the stitches worsens this process (Figure 12).
Figure 10: This child has a penetrating injury to his right hip as he falls onto the glass.
Figure 11: The broken thread particles in the child's underwear are probably dragged deep into the wound, increasing the risk of infection.
Figure 12: A wound sutured with unsuitable material. Frank from the creator flows, and the swab sample will help in microbiological diagnosis. After sutures were removed, the wound was opened and organic material was found in the pre-patellar bursa.
How should the wound be closed?
There are many wound closure agents; adhesive tapes (Figure 13), staples (Figure 14), tissue adhesive (glue) and absorbable and non-absorbable sutures.
If sutures are selected, non-absorbable sutures (nylon, silk) are the most useful materials for emergency intervention. Nylon sutures lead to less infection and provide a better wound appearance.
Because of the risk of infection, individual sutures should be selected instead of supcuticular or continuous sutures. Layer closure in traumatic wounds is not routinely recommended.
How is this wound closed?
Dry dressings are suitable for all simple incision wounds. Abrasion and bruise-type injuries require as little adherent dressings as possible. The medicated pet is suitable for most of these wounds. It can be dry, antibiotic or antiseptic solutions can be absorbed.
Does this region need to be immobilized? Wounds on the joints heal more quickly and give less pain if fixed for several days.
Is there any indication for antibiotics?
Antibiotics are rarely used. Antibiotics should not be used to cover gaps in an inappropriate surgical technique or inadequate cleaning.
Wounds with fractures, deep penetrating wounds and bites may benefit from antibiotic treatment. In these conditions, it should be borne in mind that antibiotics are not prophylactic since potential infectious organisms already exist.
Organisms that frequently infect the wound are S. aureus and Streptococcus species. Coliforms and anaerobic organisms may predominate in wounds near the hip and perineum. Animal bites, particularly cat bites, may be contaminated by Pasteurella multocida.
Figure 13: A simple wound affixed with adhesive tapes.
Figure 14: A scalp wound fastened with metal staples.
Does the child have tetanus immunity?
Tetanus prophylaxis should be given according to the condition of the wound and the immunity of the child.
A tetanus-prone wound is defined as:
If more than six hours have passed before treatment,
If contaminated with faecal material / foreign bodies,
Is located in an area contaminated with fertilizer,
If there is significant devitalized tissue,
If it's a hole-type wound,
An unimmunized child.
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