Aseptic and infected wounds.

Any damage which is followed by disturbance of integrity of cover tissues – a skin or mucosas is called as a wound.

Depending on a type of the operating force (an acute knife, blow a hammer) its directions and an orientation of the main lines of a skin (according to Langer) forms of edges of a wound can be various (reasonable, avulsion, scalping wounds, etc.).

Clinic of wounds bleeding, pain cause existence of defect of a skin or mucous.

Expression of a pain syndrome is caused by the following factors:

1) Localization of a wound (where large number of receptors: finger-tips, a peritoneum, a pleura) – severe pains;

2) character of the hurting weapon – the more acutely, the is less damage of receptors;

3) a condition of a macro organism – (there are no pains at topers, narcomaniacs, a siringomiyeliya).

Intensity of bleeding is caused:

1) localization of a wound;

2) character of the hurting weapon (the more acutely, the bleeding is stronger);

3) condition of coagulating system.

The gaping of wounds is caused by reduction of elastic fibers of a skin. Expression of a divergence of dermal edges of a wound is defined by the relation of its axis to Langer's lines.

Classification:

Taking into account the reason of damage of a wound share on:

- deliberate (they operational)

- casual (household, production, fighting)

Depending on existence in a wound of microbial flora distinguish:

Aseptic (sterile) – are put in the conditions of operational, but the name it is conditional since actually truly aseptic wounds meet seldom. However extent of bacterial pollution of operational wounds, especially pathogenic or opportunistic micro flora is much lower than a critical dose – that minimum quantity which causes infectious process. Infected any wound put out of operational during till 3 days from the moment of damage is considered.

In surgical practice there is an axiom that any casual wound should be considered infected. However existence of an infection in a wound doesn't mean obligatory development of purulent process. Its development requires a combination of factors to which the appreciable traumatisation and a necrosis of tissues, presence at a cavity of a wound of a blood, its clots, existence in a wound of sufficient concentration of pathogenic microbes belongs.

Critical level of a bacterial contamination at which in an organism can arise it is purulent - infectious process, makes 100000 microbial bodies on 1 g. tissues.

At existence in a wound of favorable habitat for microorganisms in the form of a blood and products of fabric disintegration reduces the critical level of an contamination to 10000 microbial bodies on 1 гр. tissues.

Purulent wounds, essentially differ from the infected in that infectious process already develops in them; in tissues inflammatory process, a necrosis, formation of a purulent exudates is expressed.

Allocate simple wounds when there is a damage only of a skin both mucous, and difficult if wound defect is combined with injury of muscles, bones or internals.

The wounds resulting from mechanical damage belong to uncomplicated, and in combination with combustions, radiative damage - to complicated.

In relation to cavities of a body distinguish not getting and getting. The last are characterized by penetration of the wound channel into an abdominal and thoracic cavity, a cavity of a joint, a skull, etc.

On nature of damage of tissues distinguish:

the cut are put with an acute subject, can be deep, but surrounding tissues are damaged slightly, smooth edges.

The chipped are put with a narrow subject, have the small area and a deep water, the gaping is absent, surrounding tissues aren't damaged, but damage of the deep-lying structures (nerves, vessels, organs), internal bleedings is possible. The hurt are put with a blunt subject. The wide zone of damage of surrounding tissues with development of necroses, the expressed pain syndrome is characteristic.

Crush injuries - are formed at blow by a blunt subject with a big force. All symptoms of the hurt wounds are characteristic, but the zone of a necrosis is even more, there is a compression failure the globalisasi of tissues, fractures of bones.

The lacerated – are formed at the slipping blow by a blunt subject. Uneven edges, detachment and a necrosis of a skin – sometimes on the big square are characteristic.

The chopped – are put with a serious acute subject and combine properties of the cut and hurt wounds. Deep and extensive damages of surrounding tissues, fractures of bones, crush injuries of edges, the expressed pain syndrome and a gaping, moderate bleeding are characteristic.

The bitten – result from a sting of an animal or the person. Can have appreciable depth at the small area of a lesion and always high contamination a virulent microflora, often are followed by development of a purulent or putrefactive infection, hit in a wound of toxins of animals, a rabies virus is possible.

The fire has essential differences from other wounds.

For bullet wounds existence of three zones of damage is characteristic:

1. destruction zones (wound channel),

2. zones of a direct traumatic necrosis (a bruise of surrounding tissues from influence of energy of side blow)

3. zones of molecular concussion.

On character of the wound channel mechanical wounds section on through, blind and tangent.