Surgery- Dr. Ali Adwal
– 1
st
lecture
Made by AbdAlkalk L.Q
The Wounds
-A wound is breach of normal tissue continuity
-A wound is applied to the superficial form of
tissue damage while injury is used to deeper
structures.
Types of wounds
1- Acute wound: is any wound that proceeds
through healing process with timely and
orderly way, as facial wounds that heal within
7-10 days.
2- Chronic wound is any wound that does not
proceed to healing in a timely or orderly way
as an ulcer's in the Lung.
Classification according to injury type
-Closed wounds: result from blunt trauma, usual
causes are fall, a bruise (contusion) usually result,
color change will result in bluish brown black
green.
-If the amount of bleeding is sufficient. If you
would collection in the tissue, hematoma will
result, initially this will be fluid then clot will result
within minutes or hours after few days to liquid*
Treatment
No specific treatment
-Hematoma should be evacuated by open surgery
if it is large or causing pressure.
-Aspirated by large bone needle as in cosmetically
sensitive site
-Hematoma will generally resorb without scaring
Open wounds
1-puncture wound and bites
Puncture wound is an open injury in which foreign
related and organism are likely to be carried DP
deeply into the underlying tissue
common cause is standing on nail rites associated
with high incidence of infection
Treatments
antibiotics
tetanus prophylaxis
Foreign body removed if large
animal bites may need wound excision
Complications
1- abscess formation
2- disease formation
2-Abrasion and friction burns:
Abrasion is a shearing injury of skin in which
surface us rubbed off. Most are superficial and will
heal.
Fraction burn is similar but with addition of burns.
Treatment
Cleaning with scrubby brush, residual dirt may
result in infection or traumatic tattooing.
3-Ulceration:
A cut is the result of contact with sharp object it
equivalent to incised wounds.
-A bursting type of laceration maybe inflected by a
more blust type of implement (contact with
ground) specially ear bony prominence.
Treatment:
- Wound excision and closure under anesthesia
generally damage to nerves and tendons are
greater than suspected preoperatively
4- Crush avulsion injury:
-Are open injuries where there has been severe
degree of tissue damage as in hand trapped
rollers.
- Tissue avulsion us usually at the level of the deep
fascia
-Avulsion injury maybe closed (physiological
degtoumin) *
Treatment:
-Blood spectrum antibiotics
-Tetanus prophylaxis
-Aggressive wound excision.
-Leaving wound for 2
nd
dry intention or
microvascular flaps.
Injury to internal organs:
Stab wounds maybe associated with internal organ
injuries.
Classification could be according to the level of
contamination:
1- Clean wound: as in surgical wound, made
under sterile condition and no M.O* in the
wound
2- Contaminated wound: accidental injury,
usually M.O*and dirt in the wound
3- Infected wound:pathogenic M.O present and
……….. of … pus, redness and soreness.
4- Colonized wound: As chronic situation
containing pathogenic organisms as in
pressure sore.
-Pus is an exclude, white yellow or yellow brown
formed at the site of inflammation during bacterial
or fungal infection. Which consists of protein rich
fluid, dead leukocytes, …... And ……
-Abscess is accumulation of pus in an enclosed
tissue space.
War wounds and suns hot injuries:
-Low velocity or high velocity missile injuries
produce deferent type of tissue damage.
- Low velocity injury produce entry and exit
wounds with tract in between where as high
velocity once produces cavitational effect and
severe contravention.
Treatment:
1- extensive WLE and re-excision.
2- Fasciotomy for re-limbs to preset
compartment and syndrome
3- Antibiotics and tetanus prophylaxis
Do:
1- Incise skin generally
2- Incise fascia widely
3-Identify neurovascular bundle(closed
nerve+artery) in order not to create an injury.
4-Remove all indriven clothing
5- leave wound open after surgery
6- Record all injuries in notes (important)
Not to do:
2-repair tendon or nerve(we won't apply a major
surgery only a lifesaving surgery is done)
3-insert a sensitive prostesis(ex.internal fixation in
case if there is a bone fraction because it will lead
into infection)
4-practise a chemo procedure
5-close this injury