Ebook Emergency medicine procedure (2nd edition): Part 2
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Ebook Emergency medicine procedure (2nd edition): Part 2
92General Principles of Wound ManagementLisa Freeman GrossheimINTRODUCTIONAn acute wound can be defined as an unplanned disruption in the integrity of Ebook Emergency medicine procedure (2nd edition): Part 2f the skin, including the epidermis and dermis. The goals of wound management are to restore tissue continuity and function, minimize infection, repair with minimal cosmetic deformity. and be able to distinguish wounds that require special care. The principles of wound management should be emphasize Ebook Emergency medicine procedure (2nd edition): Part 2d over the repair technique. Appropriate wound management prior to approximating the wound will allow it to heal with minimal complications. This inclEbook Emergency medicine procedure (2nd edition): Part 2
udes wound cleansing, debridement of the wound edges, wound approximation, and prevention of secondary injury.HEALING OF WOUNDED TISSUEPHASES OF WOUND92General Principles of Wound ManagementLisa Freeman GrossheimINTRODUCTIONAn acute wound can be defined as an unplanned disruption in the integrity of Ebook Emergency medicine procedure (2nd edition): Part 2tion. The second phase is the proliferative phase. The final phase is the reepithelialization or remodeling phase.Phase I consists of coagulation and inflammation. It occurs in the first 5 days. This phase is also known as the vascular phase. A fibrin clot formsa transitional matrix that allows for Ebook Emergency medicine procedure (2nd edition): Part 2the migration of cells into the wound site over a period of 72 hours. Inflammatory cells(i.e.. neutrophils, monocytes, and macrophages) kill microbes,Ebook Emergency medicine procedure (2nd edition): Part 2
prevent microbial colonization, break down soluble wound debris, and secrete cytokines. The cytokines signal synthetic cells, such as fibroblasts, to92General Principles of Wound ManagementLisa Freeman GrossheimINTRODUCTIONAn acute wound can be defined as an unplanned disruption in the integrity of Ebook Emergency medicine procedure (2nd edition): Part 2e phase. It occurs during days 5 to 14 after the injury. Fibroblasts proliferate and synthesize a new connective tissue matrix that replaces the transitional fibrin matrix. Granulation tissue consisting of fibroblasts, immature connective tissue, epidermal cells that have migrated, and abundant capi Ebook Emergency medicine procedure (2nd edition): Part 2llaries forms within the wound. Fibroblasts release collagen, a protein substance that is the chief constituent of connective tissue. At 5 days, the tEbook Emergency medicine procedure (2nd edition): Part 2
ensile strength of the wound itself is 5°o that of normal skin. Collagen formation peaks at day 7.Phase HI is known as the remodeling, reepithelializa92General Principles of Wound ManagementLisa Freeman GrossheimINTRODUCTIONAn acute wound can be defined as an unplanned disruption in the integrity of Ebook Emergency medicine procedure (2nd edition): Part 2 into a scar. The scar consists of a rich matrix with decreasing cell density, decreasing vascular density, and increasing thickness of collagen fiber bundles packed in parallel arrays.1 The wound will have 15% to 20% of its full strength at 3 weeks and 60% of its full strength at 4 months. Tensile Ebook Emergency medicine procedure (2nd edition): Part 2strength continues to increase up to1 year after wounding. The skin will eventually regain only 70% to 9O9<> of its original tensile strength.FACTORSEbook Emergency medicine procedure (2nd edition): Part 2
AFFECTING NORMAL REPAIR___________________________The most common causes of improper wound healing are tension on the wound edges, necrosis and/or isc92General Principles of Wound ManagementLisa Freeman GrossheimINTRODUCTIONAn acute wound can be defined as an unplanned disruption in the integrity of Ebook Emergency medicine procedure (2nd edition): Part 2 mechanisms), or shock. Hypovolemia is the major deterrent to wound healing in patients with hemorrhage and shock, hemorrhage from inadequate hemostasis, infection, or retention of foreign bodies. Systemic conditions such as malnutrition, immunosuppression, shock, diabetes secondary to microangiopat Ebook Emergency medicine procedure (2nd edition): Part 2hy, decreased oxygen and nutrient delivery to the wound, renal insufficiency, cytotoxic drugs, vitamin deficiency, trace metal deficiency, and collageEbook Emergency medicine procedure (2nd edition): Part 2
n vascular disease can result in poor wound healing. Polymorphonuclear leukocyte function is known to be impaired from hyperglycemia, jaundice, uremia92General Principles of Wound ManagementLisa Freeman GrossheimINTRODUCTIONAn acute wound can be defined as an unplanned disruption in the integrity of Ebook Emergency medicine procedure (2nd edition): Part 2lack of vitamins (e.g., vitamins A and C) may inhibit or prolong healing. Zinc deficiency, which is reversible, may play a role in retarding the healing process.' Anti-inflammatory drugs (e.g.. colchicine, aspirin, and glucocorticoids) disrupt macrophage function, collagen synthesis, and polymorphon Ebook Emergency medicine procedure (2nd edition): Part 2uclear neutrophil concentrations. Pretreatment or early introduction of glucocorticoids results in retarded wound repair by slowing cell proliferationEbook Emergency medicine procedure (2nd edition): Part 2
.4SCAR FORMATION____________________________________________Some 6 to 12 months are required to form a mature scar. This explains why scars should not92General Principles of Wound ManagementLisa Freeman GrossheimINTRODUCTIONAn acute wound can be defined as an unplanned disruption in the integrity of Ebook Emergency medicine procedure (2nd edition): Part 2or if the wound is in an area of excessive motion (e.g., over joints). Adequate immobilization of the approximated wound (but not necessarily the entire anatomic part) is mandatory after wound closure for efficient healing and minimal scar formation. Contractures can develop when a scar crosses perp Ebook Emergency medicine procedure (2nd edition): Part 2endicular to a joint crease. These patients may require physical therapy to prevent the loss of range of motion secondary to contractures.HypertrophicEbook Emergency medicine procedure (2nd edition): Part 2
scars result from full-thickness injuries. Hypertrophic scars are characterized by a thick and raised scar that remains within the boundaries of the 92General Principles of Wound ManagementLisa Freeman GrossheimINTRODUCTIONAn acute wound can be defined as an unplanned disruption in the integrity of Ebook Emergency medicine procedure (2nd edition): Part 2ries of the initial injury. They can develop from superficial injuries and appear to have a genetic basis. Surgical intervention rarely resolves keloids. They may be prevented or minimized by the local application of pressure dressings. Silastic dressings, glucocorticoids, and calcium channel blocke Ebook Emergency medicine procedure (2nd edition): Part 2rs.1The repair procedure may result in more scar tissue. Absorbable suture materials contribute to the formation of suture marks because of their incrEbook Emergency medicine procedure (2nd edition): Part 2
eased reactivity, whereas nonabsorbable materials do609610SECTION 7: Skin and Soft Tissue Proceduresnot. Wounds that are approximated too tightly can 92General Principles of Wound ManagementLisa Freeman GrossheimINTRODUCTIONAn acute wound can be defined as an unplanned disruption in the integrity of Ebook Emergency medicine procedure (2nd edition): Part 2the wound edges shortly after the time of injury. The skins greatest strength IS in the dermal layer. The best repair results when the entire depth of the dermis is accurately approximated to the entire depth of the opposite dermis. Accurate approximation of the epidermis gives a cosmetically appeal Ebook Emergency medicine procedure (2nd edition): Part 2ing effect to the repair but does not contribute to its strength. Wound eversion and the use of buried sutures can greatly improve healing by primaryEbook Emergency medicine procedure (2nd edition): Part 2
intention.SECONDARY INTENTIONSecondary intention involves allowing the wound to heal without any surgical intervention. The wound is left open and all92General Principles of Wound ManagementLisa Freeman GrossheimINTRODUCTIONAn acute wound can be defined as an unplanned disruption in the integrity of Ebook Emergency medicine procedure (2nd edition): Part 2ssive trauma, tissue loss, or imprecise approximation of tissue can result due to healing by secondary intention. Wound contraction by granulation tissue containing myofibroblasts is the major influence on this type of healing. Wound contraction becomes more Significant when the dermis is lost.(Conc Ebook Emergency medicine procedure (2nd edition): Part 2ave skin wounds heal with the best results. These areas often heal better by secondary intention than by primary intention. Such concave areas includeEbook Emergency medicine procedure (2nd edition): Part 2
the inner ear, the nasal alar crease, the nasolabial fold, the temple, and the concave areas of the pinna. Flat surfaces can also heal well by second92General Principles of Wound ManagementLisa Freeman GrossheimINTRODUCTIONAn acute wound can be defined as an unplanned disruption in the integrity of Ebook Emergency medicine procedure (2nd edition): Part 2convex surfaces are not optimal for healing by secondary intention. Convex stirfaces include the malar cheek, the tip of the nose, and the vermilion border of the lip.-'TERTIARY INTENTIONTertiary intention, or delayed primary closure, can often decrease infection rates. Wound closure by tertiary int Ebook Emergency medicine procedure (2nd edition): Part 2ention is accomplished 3 to 5 days following the initial injury. It is a combination of allowing the wound to heal secondarily for 3 to 5 days and theEbook Emergency medicine procedure (2nd edition): Part 2
n primarily closing the wound. It is the safest method of repair for wounds that are contaminated, dirty, infected, traumatic, associated With extensi92General Principles of Wound ManagementLisa Freeman GrossheimINTRODUCTIONAn acute wound can be defined as an unplanned disruption in the integrity of Ebook Emergency medicine procedure (2nd edition): Part 2und closure. This method may not be suitable for young children, having to return a second time for an uncomfortable procedure.During the interim period, instruct the patient to apply wet-to-dry dressing changes twice a day. Upon the patients return, assess the wound for any signs of infection. Anes Ebook Emergency medicine procedure (2nd edition): Part 2thetize andclean the wound. Scrub the wound base and edges With saline-moistened gauze and irrigate the wound to remove any dirt, debris, and granulatEbook Emergency medicine procedure (2nd edition): Part 2
ion tissue. Suture the wound to approximate and evert the wound edges. The postprocedural wound care is the same as if the wound was closed primarily.Gọi ngay
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