Wounds by
Dr. Nimer Khraim
DVMS, MVSc
Wounds
Close wound
Contusion wound In this wound the skin is damage but
remain unbroken
In contusion mostly CT may be damaged
Wounds
Abrasion wound:
these wound result from scraping or friction applied to the skin
Surgically interpretation is unnecessary
Wounds
The contusion classified in to three type
Contusion of the first degree
Characterized by rupture of capillary vessels in the skin and S\C tissue and formation of ecchymosis
Wounds
Contusion of the second degree
Characterized by rupture of large blood vessels and production of hematoma
Wounds
Contusion of the third degree
In these contusion there is considerable destruction of tissue which may undergo gangrene
Wounds
Treatment of contusion
1. Cold water irrigation
2. Astringent application
3. Iodine application
4. Massage
5. Application of compression bandage
WoundsOpen wound Incision (incised wound) Caused by sharp object, the tissue are clearly
divided and bruising of margin is minimal Deep incision may sever m. tendon blood v. and
nerves
They usually companied by h.
Wounds
Laceration They produce by blunt objects that tears
the tissue
Some laceration produce skin flab or S\C
Wounds
Punctures Its cause by sharp of blunt object and are
usually deep but have no significant opening
Tetanus has been associated with these type of wound
Wounds
Penetrating wound These wound communicate with body
cavity
They may cause internal infarction such as
general peritonitis or empyemia
Wounds May associated with sever internal injuries
such as penetration of intestine, rupture of blood v. etc. ,
if penetrating wound is suspected exploratory labrotomy or thoracotomy should be performed
Wounds
Bite wound It’s the most serous injuries
because they may provide multiple source of infection like S\C tissue, muscle and deep structure may inoculated with bacteria or virus from the saliva of biting animal
Wounds
Classification of wound according to degree of contamination
1. 0-6 hrs. minimal contamination
2. 6-12 hrs. signifiant contamination
3. 12-more gross contamination
WoundsTreatment of wound Its necessary to remove all F.B and devitalization
tissue from the wound
Debridement of an open wound should be done as soon as possible in the course of the treatment
It may required the use of spinal or local analgesia or G.A
WoundsStep of wound Debridement Clipping the hair in all area around the wound
Thorough wash with soap and water
Strong soap and detergent are best used only on
the surrounding of the wound and not in the center of the wound
Wounds The wound is gently washed with the saline sterile
solution S.S.S
Make a thorough examination of the wounded tissue
Extension of the margin of the wounded skin may required particularly in the case of destructive injuries
Wounds Area of the skin that are badly damage or
that have no capillary oozing from the margin are excised
Any facia in the wound should be excised because Its normally and particularly susceptible to colonization by bacteria
Wounds Area of m. that are a vascular, pale friable
badly damage or heavily contaminated should be excised
Nerve, major v. and tendon should be cleaned as well as possible and preserved unless they are necrotized
Wounds F.B such as hair, organic material and debris should be
removed when ever it seen
Further removal of the bacterial colonies should be done by thorough lavage of the wound by SSS or ringer solution
the addition of antiseptics and antibiotic to this solution can used
also you can use povidone iodine (1 part to 9 part of SSS)
WoundsManagement of wound infection When wound accumulate a poket of
exudates the first step of treatment is the remove of the suture and open the wound completely to provide a drainage in to the abscess
Then the wound is debrided
Wounds
Closing the wound can be done only if the Debridement is perfect with application of drainage
Wounds
Drain May used prophylactically or therapeutically
to prevent accumulation of blood, pus, serum or air in a fresh wound
Or to drain fluid that have already accumulated
Wounds A drain tube may be soft or pliable or rigid.
The purpose of the drain is to keep a
channel through with blood, pus, serum or natural body fluid can escape
Wounds
Wound healing
Inflammatory stage The immediate response to injuries is
vasoconstriction of the small v. in the area of the wound
Wound Healing Actually vascular occlusion occur at the point of
the trauma tending to control h. This response last 5-10 min. and is follow by
active vasodilatation
Soon after injuries leukocyte in the local vasculature become sticky and adhere to the endothelium
Wound Healing
The predominant cell is PolyMorphonuclear Cell PMNc
Wound HealingThe repair stage The repair process begin almost
immediately after wounding and continue as rapidly as necrotic tissue, blood clot and other debris are removed from the wound
The PMN is important in the wound healing if sepsis is present
Wound Healing
In absence of infection however wound repair proceeds normally in the complete absence of PMNc
Wound Healing
Fibroblastic Stage (modern theory)
Wound fibroblast are derived from local mesenchymal cells particularly that associate with blood v. adventasia
Wound Healing Shortly after injuries undifferentiated cells begin to
change to migratory fibroblast
After the fibroblast inter the wound they secret protein polysaccharides and various glyco-protein that make the ground sub.
The fibroblast stage last 2-4 weeks depending on
the wound
Wound HealingEpithelization stage Epithelization, proliferation and migration are the
first signs of repair and occur before any C.T has been formed in the wound
The initial stage and response of cells near the
wound is mobilization and then epithelial cells enlarge and begin to migrate down and a cross the wound
Wound Healing
Contraction stage
The size of full thickness of the wound is
diminished and is characterized by central movement of the whole thickness of the surrounding skin
Wound Healing
Factor affecting wound healing
Hypoproteinemia If serum protein conc. Is below 2gm\100ml
this will inhabit the healing process
Factor affecting wound healingAnemia and blood loss The healing wound depend on microcirculation to
supply the oxygen and other nutrient
therefore any thing that interfere with microcirculation it will cause inhabit in wound healing as in case of anemia due to blood loss
Factor affecting wound healing
Oxygen
Its require for normal wound healing, so any decrease in oxygen level will delay healing
Factor affecting wound healing
Temperature
It was reported that the wound heala faster at an environmental temp. of 30c than room temp.
Factor affecting wound healing
Uremia It will decrease wound healing because
they will change enzymes system and cellular metabolization which lead to decrease of healing process
Factor affecting wound healing
Anti-inflammatory drugs Cortisone and its derivatives decrease the
rate of protein synthesis
High dose of corticosteroid limit capillary budding, inhabit fibroblast proliferation and decrease the rate of Epithelization
Factor affecting wound healing
Vit. And minerals
Vit. A,C,E
Minerals Zink
Factor affecting wound healing
Radiation and cytotoxic drugs
They cause inhabit in deviation of local
fibroblast and epithelial cells which lead to delay or prevention of wound healing
Factor affecting wound healing
Dehydration and edema
Factor affecting wound healing
Infection Infected wound had decreased fibroblastic
activity
Bacteria change wound PH which may affect on healing process
Factor affecting wound healing
Antiseptic It may destroy bacteria but they also injure
body cells
Any solution that is not isotonic can injure
cell
Factor that influence the establishment of wound infection
Factor that influence the establishment of wound infection
Wound infection
Pathogenic and virulence of microrganism
Size of bacterium inoculums
Presence of F.B
Factor that influence the establishment of wound infection
Blood supply to the site
General health of animal
Factor that influence the establishment of wound infection
Poor management in the inatial handling of the wound which include:
In adequet Debridement Poor hemostasis Rough handling of tissue
Factor that influence the establishment of wound infection
Improper use of drainage
Poor using of dressing and bandages
Incorrect using of supportive antimicrobial
therapy
The purpose of bandaging the wound
The purpose of bandaging the wound
To minimize edema and hematoma formation
To decrease the dead space
To protect against additional contamination
and trauma
The purpose of bandaging the wound
To absorb drainage
To minimize excessive motion
Complication of the wound
Complication of the woundHemorrhage and traumatic anemia
Result from loss of large amount of blood
When h. is severe acute anemia will develop
The animal being will collapse and grasping respiration
Complication of the wound running down of pulse
pal m.m
death may occur rapidly from cerebral ischemia
Complication of the woundSyncope characterized By sudden stoppage of heart
action
the patient appear to be dead
the cause may severe h., reflex action as may occur in severe operation
Complication of the wound
Shock
in this case the function of the heart and respiration is continued and the patient un-conscious
Complication of the wound
Traumatic Neuralagia may occur at the time of the wound which
extend along the n. course or may occur during healing process
Complication of the wound
Traumatic Emphysema
this is due to infiltration of cellular T. by air
it’s a common complication of puncture
wound of resp. tract
Complication of the wound
Venous Thrombosis
it’s the result of phlebitis which appear in the vain that has been opened or contused at the site of the wound
Complication of the wound
Traumatic Fever
its happen due to absorption of toxin from the wound caused by presence of bacteria
Complication of the wound
Septicaemia and Pyemia
this complication now very little to happen because of antibiotic administration and the uses of aseptic tech.
Complication of the wound
Gangrene
this due to the invasion the wound by anaerobic organism and its associated by deep wound