IV. Table of contents of teaching

The infected wounds are traumatic wounds, in which dead tissues, and also wounds, are with the expressed clinical infection or perforation of internal organs.

Suppuration of wound and inflammation of surrounding tissues testifies to the wound infection – regardless of succeeded or not to select pathogenic microorganisms at sowing. Superficial (suprafascial) and deep wound infections distinguish.

Purulent wounds is a hearth of traumatic destruction of tissues, complicated the presence of infection; characterized development in the certain sequence of pathomorphological and pathophysiological changes, caused by mediators of inflammation (B.М.Datsenkо et al., 1995).

Description of basic phases of wound process (on в.М. Datsenko et al., 1995)

For practical work in the flow of wound process it is expedient to select three successive phases:

• purulent-necrotic, which is characterized the presence of necrotic tissues, purulent content in a wound, by infiltration of its edges. There is a high level of bacterial muddiness in this phase. Exactly at back of wound, in the hearth of the second necrosises, but not on its surface microflora which determines weight and direction of wound process flow is localized;

• phase of granulations, which is determined of wound cleansing from a purulent-necrotic sequestrum, by the presence of serum, absence of edema and infiltration, development of granulation tissue;

• phase of epithelization, which clinically shows up epithelization of wound surface and reorganization (hardening) of scar.

General principles of treatment of purulent wound

Surgical treatment of purulent wound.

Surgical treatment of purulent wound pursues the followings primary purposes:

- deleting from the organism of purulent-necrotic nidus — nonviable tissues, containing mass of high-virulent microorganisms;

- providing of terms for the valuable outflow of wound separated, evacuation of toxins, products of tissue disintegration and the same decline of general intoxication of organism;

- creation of terms for the favourable flow of inflammatory process is declines of hyperhydration and acidosis and other

Length of a skin cut, if localization of abscess allows, must answer his extent. It improves the terms of draining of purulent cavity and diminishes the sickliness of bandaging.

All of nonviable tissues are subject an obligatory delete.

Important for a surgeon is knowledge about the ways of distribution leaving to rot.

Types of the second stitches (on S.S.Girgolav, Т.D.Аrjev):

• second early stitch – laid on a wound which granulates, on 8-15 days, without the clinical signs of infection;

• second late stitch – laid on a wound which scarring, on 20-30 days, without the clinical signs of infection, with excision of scars and granulations and mobilization of wound edges.

To the methods which promote efficiency of surgical treatment of wound and it subsequent treatment belong:

Draining of wounds (active and passive).

Purulent exudation, products of tissue disintegration and bacterial toxins is thus deleted. Distinguish passive and active draining of wound. In first case purulent excretions follow from a wound by virtue of weight, in the second an outflow is provided by the special devices which work on rarefaction.

Passive draining of wound is carried out by the different type of drainages. More frequent to that end apply tubular drainages, perforated (on the size of wound) tubes which make from rubber, polyethylene and other

The method of active aspiration of purulent content of cavity of wound was first applied М.S. Subbotin (1888) and S. Bulau (1889) for treatment of empyema of pleura. S.I. Spasokukotsky (1924) suggested to utillize the water-jet suction in these aims. In 1952 K. Redon utillized vacuum draining of wound for the delete of its content after the resection of thyroid.

With the purpose of vacuum draining it is possible to utillize an ordinary rubber pear which is tacked to drainage in the compressed state; as far as its straightening in the system a «wound-pear» is provided certain rarefaction.

A method of the permanent «running» washing of purulent wound with vacuum-aspiration of its content is presently the most effective method of its treatment on the basis of principle of draining. For washing it is necessary to aim to utillize modern antiseptics (Decasan).

Imposition of medical bandages with preparations which provide the combined action:

• аntimicrobial

• anaesthetic

• antiphlogistic

• controlled dehydrate.

Immobilization promotes resistibility of organism. Rest is provided the staggered organ; otherwise formation of granulations and revascularization slowed, arise up hemorrhage and new hearths of necrosis, which create an environment for reproduction of bacteria. Splinting and fixing of the staggered extremity in the elevated position hinder distribution of infection.