Embedded Files
The core principle across all specific wounds is that external appearance may hide substantial deeper damage, necessitating thorough exploration based on the cause of injury.
The core principle across all specific wounds is that external appearance may hide substantial deeper damage, necessitating thorough exploration based on the cause of injury.
1. Lacerations
1. Lacerations
- Simple Lacerations: Generally managed by complete closure if not grossly contaminated; requires thorough lavage and debridement first.
- Deep Lacerations: Underlying damage to muscles, tendons, and blood vessels must be surgically resolved before the wound is closed.
- Tension Management: If tension exists at the wound edges, use tension-relieving sutures, sliding tissue flaps, or grafts.
- Contaminated Lacerations: Primary closure is often avoided; these are treated as open wounds or closed with drains.
2. Bite Wounds
2. Bite Wounds
- Cat Bites: Characterized as small, penetrating wounds that frequently become infected; they are treated as abscesses using culture, debridement, antibiotics, and drainage.
- Dog Bites:
- Nature: Slashing injuries where the majority of tissue damage (e.g., broken ribs or organ damage) is beneath the surface.
- Surgical Requirement: Wounds should be surgically extended as far as necessary to determine the true extent of the injury.
- General Management: Stabilize the patient first; complete closure is usually not recommended (except after en bloc debridement) because sites are considered contaminated.
3. Degloving Injuries
3. Degloving Injuries
- Cause: Result from shear forces (e.g., fan belts or motor vehicle accidents).
- Physiologic Degloving: The skin remains but is freed from underlying fascia; necrosis may develop over several days if the blood supply is lost.
- Debridement Strategy: Often requires marked and repeated debridement.
- Early Phase: Salvage tissue with questionable viability initially and remove necrotic tissue in subsequent sessions.
4. Gunshot Injuries
4. Gunshot Injuries
- Pathophysiology: High-velocity projectiles create shock waves that cause blunt force trauma and vascular damage deep within the tissue.
- Status: Always considered contaminated; primary closure is generally not recommended.
- Specific Anatomical Protocols:
- Abdomen: Indication for an exploratory celiotomy.
- Thorax: May require a thoracotomy if hemorrhage or pneumothorax cannot be managed conservatively.
5. Pressure Wounds (Decubital Ulcers)
5. Pressure Wounds (Decubital Ulcers)
- Etiology: Result from pressure-induced necrosis; predisposed by immobility, paraplegia, or improper padding.
- Prevention (Primary Goal): Frequent repositioning, adequate nutrition, cleanliness, and padded bedding.
- Management:
- Mild: Managed with debridement and protective bandaging.
- Severe: Requires extensive surgery, development of a granulation bed, and closure via advancement flaps or pedicle grafts.
Page updated
Google Sites
Report abuse