Infected Wounds: Description, Surgical Treatment, and Treatment Characteristics

Infected wounds are always an unpleasant surprise. The breach of the integrity of the skin itself does not pose a danger to humans, but if a bacterial flora joins, the inflammatory process begins, accompanied by an increase in local temperature, redness, pain, and impaired limb function and / or the organ on which the wound is located.

Definition

A wound is a violation of the integrity of the skin or mucous by a mechanical method. Possible damage to underlying tissues and aggravation of traumatic conditions. This is one of the types of injury that always poses a threat to human life and health. It is an important aspect of the study in surgery.

Wound is a traumatic situation that leads to a wound.

Clinic

Symptoms that accompany infected wounds depend on their number and the severity of the condition. There are several local signs, inherent in any injury of this kind.

1. Pain. At the time when the integrity of the skin is broken, nerve endings are damaged, and a significant amount of cytokines and prostaglandins are released that stimulate unpleasant sensations. The sensitivity of tissues in different parts of the body is not the same. It is most pronounced near the nerve trunks, at the periosteum, in the tooth pulp, in the peritoneum and pleura. Parenchymal organs, like the brain, do not have pain receptors.
2. The glow of the wound depends on its width and depth, as well as on the number of broken fibers. The largest is observed when muscle is damaged and a significant fat layer.
3. Bleeding. This sign is closely related to the place of injury. If large vessels are damaged, especially arteries, then blood loss will be significant, but the breakage of the capillaries will not cause significant damage to health.

If a superficial wound is applied, the general reaction of the organism will be insignificant. But with multiple deep cut wounds, the symptoms will be due to the location of the injuries, the degree of hemorrhage and the attachment of a secondary infection. This is dangerous by the development of hemorrhagic or hypovolemic shock, cerebral hypoxia, sepsis and other complications.

Classification of wounds

For doctors, there is a single directory of diseases, in which an infected wound is entered. ICD 10 assigned her the code T80-T88. This heading is responsible for human traumas and their complications. But there is another classification.

For example, by the nature of the weapon, a gunshot wound and a knife are made.

On the cutting edge of the traumatic agent, it is possible to distinguish such species as: chopped, chopped, chopped, torn, bitten, bruised, smashed, and so on.

On the form of the received defect mark linear, patchwork, holey damages.

The depth of penetration of the traumatizing agent distinguishes between superficial, penetrating, through and tangential wounds.

There is even a classification indicating the extent to which the infected wound is divided (ICD 10 does not distinguish it):

• Aseptic (after primary surgical treatment);
• Contaminated (there are microbial bodies, but there are no signs of inflammation yet);
• Infected (redness, swelling, local temperature increase, pain and change in function).

The wound healing depends on what it was applied. There are three options for the development of events:

• Primary tension (wound clean, shallow, applied with a sharp object);
• Secondary tension (a large number of granulations, infected wounds);
• Healing under a scab (coagulation necrosis from a chemical burn).

Wound process

The wound process is a succession of changes that occur in the wound in the process of its production and healing, as well as the reactions of the organism caused by the given 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 invented 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 trauma. Immediately after the injury, the destruction of a part of the tissues, their bruising and cavitation, and the formation of hematomas are observed. In the first seconds there is a vascular spasm, which is replaced by a sharp expansion of blood vessels and bleeding. After a short time, the blood flow slows down and a blood clot forms. In parallel with this , inflammatory mediators accumulate in the wound , which attract white blood cells, phagocytes and mast cells. Bacteria, accidentally recorded on the wound surface, are eliminated and absorbed by local cellular immunity.

Still some time later around an injury there is an inflammatory shaft from the dead cells and swelling. The vascular network is squeezed, secondary necrosis is formed. It is at this point that pain appears and the function of the affected area is disrupted.

The second phase of the wound process begins in three days, but there is no clear boundary. The inflammatory process continues, and an infected wound results from a soft tissue injury. The ICD code is changed by several points. Mechanical cleaning of the wound stimulates the growth of granulation tissue, and the removal of dead bacteria by phagocytes reduces inflammation. The process of regeneration begins, new blood vessels are formed, dense collagenous tissue grows, and a fresh soft scar appears on the wound site.

In ten to fourteen days, the third phase begins - scarring and epithelialization. Collagen filaments become more dense, the vessels no longer germinate. Simultaneously, a layer of epidermis is formed. The new scar has a gently pink color, but eventually the capillaries disappear, and it pales, becoming almost invisible.

Under this scheme, all are healed, not only infected wounds. Of course, there are always individual variations of these three phases.

Response of the body to an infected wound

The general reaction can be divided into catabolic and anabolic phases. During the first (up to the 4th day), all vital processes intensify: the temperature rises, metabolism speeds up, a person loses weight, protein synthesis is inhibited and the permeability of cell membranes decreases. The body is tuned for regeneration.

The second phase comes on the fourth day after the injury, and everything gradually falls into place. The body weight is restored to the previous level, the metabolism is normalized, and with it the temperature falls. The activity of adrenal hormones increases slightly.

Healing of wounds

Each tissue has a certain tendency to regenerate. Not all cells produce their own equally well, especially if it is an infected wound (ICD does not give any recommendations on this matter). The speed and quality of healing depends on the conditions on the affected area. If there is dry, clean and there are no foreign bodies or bacteria, then the process will proceed faster. And, accordingly, on the contrary. The general state of the organism also affects the rate of regeneration. In young and healthy people, healing is easier, but the presence of chronic diseases, large blood loss or vitamin deficiency can aggravate the course of the disease and delay the recovery process for several weeks or even months.

Surgical treatment of wounds

The purpose of primary surgical treatment is mechanical cleaning 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 solution, and then treated with a 1% iodine solution. The operating field is covered with sterile napkins, and after anesthesia the edges of the wound are spread and spread apart. This is necessary in order to make it easier to remove foreign bodies and dirt. For example, if a patient has an infected wound of the foot, then most likely, it has particles of earth.

Necrotized tissue is excised. If necessary, the wound can be increased for better access to all blind spots and possible pockets. If there are damaged large vessels, then they are bandaged, and nerves are stitched. After the surgeon has finished removing all unnecessary, the wound is tightly sewn and an aseptic bandage is applied. Some exceptions are mentioned in the ICD. The infected wound of the foot, for example, should remain open, as in the soil to which it was contaminated, live anaerobic bacteria causing decay. Yawning damage ensures a constant access of oxygen to the tissues, which means that it does not allow the development of microorganisms.

Therapy of purulent wounds

Clinical signs, by which it can be determined that a person, for example, an infected shin wound, appears on the second-third day after the injury. This is facilitated by the presence of signs of inflammation and pathogenic or conditionally pathogenic flora. In the treatment of such lesions, one should focus on the type of bacteria and select the appropriate antibiotic sensitivity. The general approach is this:

• A thorough cleansing of the wound;
• Treatment with antiseptics;
• Setting drainage for better outflow of infected fluid;
• Stimulation of the local immune system.

General treatment

Antibiotics remain the cornerstone in the treatment of infected wounds. The drug, the method of administration, the dose and the frequency of reception directly depend on the microorganism that caused the 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 desired level. Mobilization of the protective factors of the body helps to avoid complications such as sepsis, fever and others.