TYPES OF WOUNDSCOLLEGE OF DENTISTRY

2012-2013GENERAL SURGERY

WOUNDS –TYPES&MANAGMENTSIMPLY IT IS DISCONTINUITY OF EPITHELIAL SURFACE.TYPES;GENERAL CLASSIFICATION;TIDY AND UNTIDY:TIDY: SHARP CLEAR CUT CLOSED PRIMARLY.UNTIDY:CRUSHING,TEARING,WITH DEVITALISED TISS-

UE.THIS NEEDS TO DO WOUND EXCISION TO MAKE ITTIDY AND SO CLOSE IT EITHER PRIMARLY(PRIMARY

CLOSURE),OR DELAYED PRIMARY OR EVEN SECOND- ARY CLOSURE OR SUTURE.

TIDY & UNTIDY TYPESTIDY WOUND – PRIMARY SUTURING

UNTIDY WOUND—SUTURING AFTEREXCISION&CLEANING

OTHER CLASSIFICATION OF TYPES OF WOUNDS CLOSED & OPENED.

CLOSED WOUNDS: CONTUSION AND HAEMATOMA.BLUNT TRAUMA,NO, SKIN CUT.OPENED WOUNDS:

ABRASION:SCRAPING OF SUPERFICIAL SKIN LAYERDUE TO FRICTION.

CLOSED WOUNDSCONTUSION -- HAEMATOMA BLUNT TRAUMA—SKIN INTACT

OPEN WOUND--ABRASIONSUPERFICIAL SKIN SCRAPING DUE TO FRICTION

OPEN WOUNDS..CONT,D--INCISED WOUND :CLEAR,CLEAN CUT e.g.SURGICAL

WOUNDS,RAZOR CUT OR CUT WITH KNIVES.--LACERATED WOUND:IRRIGULAR SHAPED WOUDND

USUALLY CONTAMINATED,COMMONLY SEEN IN R.T.A.,FALL FROM A HEIGHT,AND BLUNT TRAUMA.--CRUSHING WOUND: IT IS SKIN DEGLOVING,&DEVI- TALISED TISSUE WITH CLOSED FASCIAL COMPARTM-

ENT SYNDROME ,WHICH NEEDS URGENT FASCIOT OMY.

---PENETRATING WOUND:STAB WOUND LIKE KNIFE STAB .

INCISED WOUNDS

LACERATED WOUND-IRRIGULAR EDGE

CRUSHING WOUNDSWITH OR WITHOUT FRACTURE BONES DEGLOVING SKIN AND MUSCLE CRASH

PENETRATING WOUND

BITE WOUND--CONTAMINATEDHUMAN BITE ANIMAL BITE

OPENED WOUNDS—CONT,DBITES:ANIMAL & HUMAN WITH HIGH INCIDENCE OF

INFECTION.

MISSILE INJURY WOUNDS:2 TYPES OF MISSILES: LOW VELOCITY LIKE

PISTOL;CAUSING DAMAGE ALONG THE TRACK THR-OUGH IT THE BULLET PASSED.HIGH VELOCITY MISSILE: DAMAGE A LONG THE TRACK AND AWAY FROM THE TRACK DUE TO THE SHOCK WAVE CAVITATIONAL EFFECT LIKE BONE FRAGMENTA-

TION OR LIVER SHATTERING WHEN THE MISSILE PASSES BESIDE THEM ,AND NOT NECESSARY THROUGH THEM.

PISTOL MISSILE—LOW VELOCITY

HIGH VELOCITY MISSILELOW & HIGH VELOCITY MISSILE HIGH VELOCITY MISSILE

MANAGEMENT OF WOUNDS---FIRST ABCDE RESUSSCITATION.INCLUDING

PRESSURE ON THE BLEEDING WOUND.---TAKE HISTORY ; WHEN WAS THE ACCIDENT?

---PROPHYLAXIS AGINST TETANUS.---ANTIBIOTICS ;PARTICULARLY LACERATED WOUND

EVEN GIVE ANTIBIOTIC AGAINST ANAEROBIC INFEC- TION.

---TAKE PATIENT TO THE THEATRE. CLEAN THE WOUND PROPERLY WITH NORMAL

SALINE ,ADD SOME ANTISEPTIC LIKE POVIDONE IODINE (BETADINE) .

WOUND MANAGEMENT---CONT,D---INSPECT THE WOUND:

CLEAN INCISED OF LESS THAN 6 HOURS DO PRIMARY SUTURING OR CLOSURE.ANY NERVE OR TENDON CUT,DO SUTURING.

IF CONTAMINATED DIRTY,CLEAN & WASH,DO N,T CLOSE THE WOUND BUT LEAVE IT OPENED FOR

4-6 DAYS AND THEN DO SUTURING SO CALLED DELAYED PRIMARY SUTURING.

ALL LACERATED,CRUSHED ,BITES & MISSILES DO, PROPER WOUND EXCISION AND DEBRIDEMENT INCLUDING ALL DEAD TISSUES AND DEBRIS ,AND DOFASCIOTOMY IF THE LIMB SWOLLEN & OEDEMATOUS AND PAINFUL.

THE WOUND SHOULD LEFT OPENED & CLOSE IT AFTER 4-6 DAYSOR EVEN AFTER 2 WEEKS (SECONDARY SUTURING).

TO SUTURE OR NOTIF YOU HAVE A WOUND WHICH YOU ARE IN SUSPICI-

OUN,REGARDING CLEANLINESS OR CONTAMINATION DO NOT SUTURE.

WHEN TO REMOVE THE STICHES? FACE , SCALP & NECK AFTER 5-7 DAYS AFTER SUTUR-ING ,BECAUSE OF GOOD BLOOD SUPPLY.ABDOMEN;AFTER 7-10 DAYS.

UPPER LIMBS;AFTER 7-10 DAYS.BACK & LOWER LIMBS 10-15 DAYS.

NOTE:DO N,T COUNT DAY OF SURGERY .

TYPES OF SURGICAL WOUNDS ACCORDINGTO RATE OF INFECTION

CLEAN WOUND:HERNIA,THYROID,BREAST-INFECTION RATE 1-2%.

CLEAN CONTAMINATED:ORAL SURGERY,GASTRIC,SM-ALL BOWEL SURGERY,CHOLECYSTECTOMY-INFECTION

RATE LESS THAN 10%. CONTAMINATED WOUND: APPENDICECTOMY,

RATE OF INFECTION 15-20.% DIRTY WOUNDS:DRAINAGE OF ABSCESS,

RATE OF INFECTION LESS THAN 40%

CHRONIC WOUNDSCHRONIC ULCER-VENOUS ULCER BED SORE,PRESSURE SORE,DECUBITUS

ULCER