Wounds and

woundhealing
Closed and open soft
tissue injuries

Ferenc Urbán
Injuries by the causing energy

 Mechanical trauma: open or closed injuries

 Thermical trauma: combustion – burning
 congelation – freezing
 Chemical trauma: coagulation
 colliquation
 Radioactive injuries
 Combined injuries e.g. laboratory accidents,
explosions
Injuries

 Monotrauma
 Multiple trauma
 Polytraumatization
Life threatening!!!
Mechanical injuries
 Open injuries –
wounds

 Potencially open

 Closed injuries
Closed mechanical injuries
 Commotion
 Contusion
 Dislaceration
 Distorsion
 Elongation
 Distraction
 Rupture
 Luxation – Dislocation
 Fracture
Commotion

 Brain

 Spinal chord

No morphological change
Contusion

 Morphological
changes
Dislaceration
 Distraction
 Elongation
 Distorsion
 Rupture
Conservative treatment
Operative treatment
Operative treatment
Dislocation
Décollement – potencially open
injuries
Compartment syndrome – Volkmann’s
ischemic contracture
A case of compartment syndrome after
electric shock
Histology
Open mechanical injuries - wounds
 Operative wounds

 Casual wounds
Wounds

 Vulnus abrasum
 Excoriation
 Abrasion
Vulnus punctum
Vulnus scissum&caesum
Vulnus contusum
Vulnus ruptum
Vulnus lacerum
Vulnus sclopetarium
 Low velocity shot
wound
 High velocity shot
wound
 The force of the bullet:

 mv2
2
Vulnus morsum
Woundhealing: the aim of it
 Primary bleeding
control
 Prevention of drying
 Prevention of infection
Conditions of wound healing
 Biological:  Physical:
 Good oxygenization &  Clean wound
blood supply  Wet, stable microclima
 Vitality of the rezidual
tissues
 Intact innervation
 Acceptable
macrophag function
The forms of woundhealing
 Sanatio per primam  Sanatio per secundam
intentionem – primary intentionem –
woundhealing secondary
woundhealing
The woundhealing process
 1. inflammatory phase (2-3 days)
 2. proliferation (4-7. days)
 3. reparation (from the 8th day)

Scar tissue
Woundcare (Paul Leopold Friedrich
1864-1916)
 Examination of the wound for checking complications, infection
control
 Tetanus and if it is necessary rabies prophylaxe
 Operation
 A/ Preparation of the patient and the wound for definitive treatment
 B/ Anaesthesia
 C/ Woundtoilette and excision
 D/ Repair of the anatomical structures
 E/ Dressing
 F/ Documentation
 Follow up
 A/ Dressing changing, „second look”
 B/ Removal of stitches
 C/ Rehabilitation
First aid
The Moberg scheme
Anaesthesia
 Total analgesia is
necessary
Debridement
 Extraction of devitalized and contamined
tissues, foreign bodies, etc.
Primary suture
Primary delayed suture
Secondary suture
 Early secondary  Late secondary suture
suture on the 2nd after 4-8 weeks
week
After excision of the
scar tissue
Complications
 Seroma, haematoma
 Dehiscentia, disruption, eventeration
 Hypertrophic scarformation
 Keloid
 Woundinfection
Anaerobe infections
 Emphysematous
gangrene
(gasgangrene)
Tetanus
 Prevention
 Surgical
 Vaccination
o Tetanus toxoid
o Human
immunglobuline
/Tetig500/
o Animal serum
Rabies prophylaxe
 Active immunization
 Passive for
immunsuppressed
people
Thank You For The Attention