wounds by dr. nimer khraim dvms, mvsc. wounds close wound contusion wound in this wound the skin is...

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

pocket

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


Oxygen

Its require for normal wound healing, so any decrease in oxygen level will delay healing


Temperature

It was reported that the wound heala faster at an environmental temp. of 30c than room temp.


Uremia It will decrease wound healing because

they will change enzymes system and cellular metabolization which lead to decrease of healing process


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


Vit. And minerals

Vit. A,C,E

Minerals Zink


Radiation and cytotoxic drugs

They cause inhabit in deviation of local

fibroblast and epithelial cells which lead to delay or prevention of wound healing


Dehydration and edema


Infection Infected wound had decreased fibroblastic

activity

Bacteria change wound PH which may affect on healing process


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


Wound infection

Pathogenic and virulence of microrganism

Size of bacterium inoculums

Presence of F.B


Blood supply to the site

General health of animal


Poor management in the inatial handling of the wound which include:

In adequet Debridement Poor hemostasis Rough handling of tissue


Improper use of drainage

Poor using of dressing and bandages

Incorrect using of supportive antimicrobial

therapy

The purpose of bandaging the wound


To minimize edema and hematoma formation

To decrease the dead space

To protect against additional contamination

and trauma


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


Shock

in this case the function of the heart and respiration is continued and the patient un-conscious


Traumatic Neuralagia may occur at the time of the wound which

extend along the n. course or may occur during healing process


Traumatic Emphysema

this is due to infiltration of cellular T. by air

it’s a common complication of puncture

wound of resp. tract


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


Traumatic Fever

its happen due to absorption of toxin from the wound caused by presence of bacteria


Septicaemia and Pyemia

this complication now very little to happen because of antibiotic administration and the uses of aseptic tech.


Gangrene

this due to the invasion the wound by anaerobic organism and its associated by deep wound

wounds by dr. nimer khraim dvms, mvsc. wounds close wound contusion wound in this wound the skin is...

Documents

type of wound slide

wounds classification

wounds abrasion wound

wounds contusion

penetrating wound

wound result

wounds area

wounds laceration