Incised wound

The wound is washed with running water. The skin around the cut is cleaned using a gauze swab, the edges of the wound are treated with an antiseptic, and then the cut is closed with an aseptic bandage. In case of heavy capillary or venous bleeding, use a pressure bandage. In case of arterial bleeding, apply a tourniquet to the shoulder or thigh (application of a tourniquet to the forearm and lower leg is irrational even with a low wound location). In all cases, including relatively small cuts without heavy bleeding, the patient should be taken to a medical facility as soon as possible, since early treatment can reduce the number of infectious complications.

Incised wounds less than 24 hours old and in the absence of signs of inflammation are subject to primary surgical treatment. Depending on the location and size of the damage, PSO can be performed under local anesthesia or general anesthesia. The wound is washed generously with a solution of peroxide and furatsilin, examined for damage to muscles, tendons, nerves and blood vessels. If there are injuries, the muscles are sutured with catgut, primary sutures are placed on the tendons (only if the injury is no more than 6 hours old), small vessels are ligated, and the nerves are sutured.

The walls and edges are excised, the wound is washed again with peroxide and furatsilin, sutured in layers and drained using a rubber outlet, a half-tube or a tube with a bulb. If necessary (in case of damage to large muscles, tendons, etc.), the limb is immobilized with a plastic or plaster splint. After the operation, painkillers and antibiotics are prescribed, and dressings are performed. The drainage is removed after 2-3 days. If the course is favorable, the wound heals within 7-10 days, after which the doctor removes the stitches. Further treatment and rehabilitation tactics depend on the presence or absence of damage to tendons, muscles and other anatomical structures.

The tactics of conservative measures are determined by the patient’s condition and the amount of blood loss. If the loss is less than 1 liter, the systolic pressure is more than 90 mmHg. Art. and pulse less than 100 beats/min, intravenous infusions are not required. With blood loss of less than 1 liter in combination with lower blood pressure and rapid pulse, as well as with blood loss of up to 1.5 liters, blood transfusions and plasma substitutes are performed. In case of severe and massive blood loss, large doses of plasma substitutes, blood and various solutions are transfused. During treatment, diuresis is monitored and, if necessary, stimulation is carried out with furosemide and aminophylline.

No stitches are applied to incised wounds older than 24 hours; such injuries heal by repeated tension. The wound is regularly washed, drained if necessary, purulent leaks are opened, etc. The patient is prescribed analgesics and antibiotics. Recovery time depends on the characteristics of the injury and the severity of the purulent process. All operations to restore tendons, nerves and blood vessels are carried out as planned, after complete healing of the wound.

In case of damage to internal organs, appropriate surgical interventions are performed: in case of damage to the lung - thoracotomy, in case of damage to the abdominal organs - laparotomy, etc. The volume of the operation is determined taking into account the degree of destruction of a particular organ; usually, with incised wounds, organ-preserving interventions are possible (suturing the organ or resection of part of it). The surgical incision is sutured layer by layer and drained. In the postoperative period, antibiotics and analgesics are prescribed, and dressings are performed.

Damage to the flexor tendons of the fingers and hand

Damage to the flexor tendons of the fingers and hand is a very complex injury that requires specialized treatment and a long period of rehabilitation. Even a small wound on the hand can be complicated by damage to the flexor tendon, which leads to the inability to bend the finger or hand.

Anatomically, there are 5 zones of injury to the finger flexor tendons:

Zone I is located distal to the insertion of the superficial flexor digitorum;
Zone II is represented by the fibro-osseous canal (the gap from the annular ligament A1 to zone I);
Zone III includes the space from the carpal tunnel to the annular ligament A1 of the fibrous tendon sheath;
Zone IV is represented by the carpal tunnel;
Zone V is located proximal to the carpal tunnel.

Fig.1. Areas of damage to the finger flexor tendons

There are open and closed injuries to the flexor tendon. The vast majority of flexor tendon injuries are open. Even a small wound on the hand or fingers can be complicated by tendon damage. Closed injuries to the flexor tendons are extremely rare and the most common cause of their occurrence is a sudden intense load on the tendon (lifting weights, falling, etc.).

Symptoms:

The most important symptom of damage to the finger flexor tendon is a violation of its function: the inability to flex the finger at any of the joints or the hand at the wrist joint.

Fig.2. Diagram of an isolated injury to the deep flexor tendon

Diagnosis of flexor tendon injuries.

Most often, to make a diagnosis, a thorough study of the patient’s medical history and disease, and an examination of the patient is sufficient. Damage to the flexor tendon leads to a functional deficit—impaired flexion of the finger or hand. With open wounds of the hand and forearm or with chronic injuries, tendon damage can be combined with damage to nerves, blood vessels and other anatomical structures, which requires a thorough knowledge of anatomy and specialized training from the doctor.

Also, to clarify the diagnosis and carry out differential diagnosis, in some cases additional studies are required, such as radiography, ultrasound, computed tomography, magnetic resonance imaging.

Fig.3. Incised wound of the hand with damage to the finger flexor tendons (the patient cannot bend the finger independently)

Treatment for flexor tendon injuries.

The only treatment for flexor tendon injuries is surgery.

The type of surgical treatment depends on many factors, such as:

Tendon injury area;
Presence of associated injuries (vessels, nerves, bones, etc.);
Statute of limitations for the injury;
Nature of injury (open or closed injury);
Individual characteristics.

Primary surgical treatment of the wound:

For acute open injuries, the first stage of treatment is primary surgical treatment of the wound, which includes washing the wound with mechanical removal of mechanical impurities and foreign bodies, excision of crushed and non-viable tissue, stopping bleeding, revision of the wound, in order to accurately identify all damaged structures and install the final diagnosis, as well as suturing the skin. In some cases, in the presence of appropriate conditions and qualified personnel, and the absence of contraindications, primary surgical treatment of the wound can be supplemented by primary restoration of the flexor tendons.

Types of surgical interventions for damage to the flexor tendons:

Tendon suture - there are many different types of tendon sutures; the choice of a specific type depends on the area of tendon damage and the skills of the surgeon. The main requirement for a tendon suture is to ensure strong, sufficiently long-term fixation and good adaptation of the ends of the tendon, even with multiple injuries.
Tendon reinsertion involves suturing the tendon to its insertion site. Performed when tendons are damaged in zone 1. It is performed using a removable transosseous suture.
Primary tendoplasty. Flexor tendon tendoplasty is the replacement of a tendon with an autograft (i.e., transplantation of one's own tendon (most often the palmaris longus tendon) in place of the flexor tendon). Performed when primary suture of the tendon is not possible.
Two-stage tendonoplasty is performed for chronic injuries of the flexor tendons. Due to the fact that the damaged tendon was not repaired in a timely manner, the channel through which the tendon passes changes, which prevents the tendon from sliding properly in the channel. In addition, the ends of the tendon undergo degenerative changes. In this regard, suturing the tendon is impossible and impractical. The first stage of tendonoplasty is the installation of a silicone prosthesis (tube) into the tendon canal for a period of 3-6 months. During this period, a new channel is formed around the silicone tube. After 3-6 months, the second stage of tendonoplasty is performed - transplantation of a tendon graft to the site of a silicone prosthesis.

Any surgery on the wrist flexor tendons is extremely difficult and must be performed by a qualified hand surgeon.

The intervention, if necessary, can be supplemented by intervention on nerves, blood vessels, ligaments and bones.

After the operation, a rigid plaster or plastic bandage is applied for a period of 4 weeks and rehabilitation treatment is prescribed, which should begin 1-2 days after the operation and includes physical therapy, physiotherapeutic procedures, paraffin therapy, and massage.

Types of wounds and their treatment

A wound is mechanical damage to body tissue, most often the skin, sometimes mucous membranes and internal organs. Wounds can be obtained at home, at work, especially often during physical labor, during games and sports. Falls, accidents, fights, animal attacks, and many other situations are accompanied by the appearance of wounds. It’s no coincidence that they rank high on the list of reasons to go to the emergency room.

Characteristic signs of a wound:

divergence of edges in the damaged area (gaping);
bleeding;
pain.

Some wounds can be healed on their own at home, but often require qualified medical care to avoid purulent complications and ensure rapid healing.

Types of wounds

According to the severity of the wound, they are classified into:

superficial—only the skin and/or mucous membranes are injured;
deep - in addition to the skin, the soft tissues located underneath it, blood vessels, nerves, and internal organs are damaged. There are two types of deep wounds:
penetrating—the wound channel ends in the cavities of the body (abdominal, pleural, pelvic, etc.), the internal organs located in them may be damaged, but not always;
non-penetrating - the wound channel ends blindly in the soft tissues.

Superficial wounds can be treated independently; for deep, especially penetrating wounds, consultation with a surgeon is required.

Depending on the nature of the wound damage, there are:

Pricked - they are characterized by a large depth with a small area of skin damage. Such wounds are inflicted with sharp long objects, such as a knife, an awl, or a nail. Puncture wounds can appear deceptively mild—they appear minor in appearance, the pain is mild, and there may be no bleeding at all. In fact, they are fraught with damage to deep-lying soft tissues, internal bleeding and suppuration - oxygen does not reach the interior, creating ideal conditions for the proliferation of anaerobic bacteria;
Incised wounds are distinguished by smooth edges and shallow depth; They are applied by all types of flat sharp objects (blades, glass, sometimes even paper). The danger of incised wounds lies in damage to large vessels, nerves, tendons, internal organs, in other cases they heal quite quickly;
Chopped wounds are similar to cut wounds, but they are inflicted by striking with a sharp object (saber, axe), so the cut is accompanied by a bruise, and there may be bone damage;
Bruised wounds are inflicted with a blunt, heavy object, causing hematomas, sometimes internal ones. Skin lesions are usually small with minor bleeding;
Lacerations have jagged edges, which makes them difficult to heal. They appear when a wounding object slides and simultaneously presses on the skin;
Gunshot wounds are caused by bullets fired from a weapon. Due to strong pressure and burns, the skin, soft tissues, and bones are significantly damaged and do not heal well. In this case, the area of damage is small, and bleeding is insignificant.

An important characteristic of a wound is the presence of infection in it. Wounds made under sterile conditions are considered clean: these are surgical incisions performed by a doctor during operations. Wounds with purulent discharge are called infected, and all others are called contaminated. This means that microbes are present in the wound, there are no signs of an infectious process, but there is a risk of its development.

First aid for wounds

The wound must be properly treated immediately to reduce the risk of infectious complications and speed up healing:

Remove dirt and foreign objects (chips, splinters, soil, etc.) from the damaged surface;
Wash the wound with antiseptic solutions (chlorhexidine, hydrogen peroxide, which not only destroys germs, but also stops bleeding);
If there is a lot of blood, apply a tourniquet or a pressure bandage to compress the damaged vessels; in this case, peroxide will not help;
The edges of the wound can be treated with an alcohol solution of iodine or brilliant green;
Apply an antibacterial healing cream to the cleaned wound surface and apply a sterile bandage on top.

When to go to the emergency room?

Professional medical help should be sought in the following cases:

Deep wounds, suspected damage to internal organs, bone fractures;
Severe bleeding that cannot be stopped on your own. If a tourniquet is applied, you also need to go to the hospital, since this is a temporary measure;
Wounds with uneven edges;
Heavy contamination, especially with soil, rust (high risk of tetanus);
Signs of wound suppuration or deterioration of the patient’s well-being (fever, nausea).

When visiting on the first day, the doctor will perform primary surgical treatment (PST) of the wound: after anesthesia, he will remove dirt and damaged tissue, blood clots, and, if necessary, apply sutures. After this, a healing period begins, which takes on average 7-10 days.

For later visits, PSO is not performed; the wounds heal through suppuration or under a crust, which takes longer - about two weeks. Periodically, the doctor treats the wound, removing pus if necessary, and then applies bandages to speed up healing.

With severe defects, spontaneous healing may not occur. Then the patient is prescribed plastic surgery with a displaced or free skin flap.

Argosulfan® for wound treatment

Cream for external use Argosulfan® has a dual effect: antimicrobial and wound healing. The main component of the drug is silver sulfathiazole. When the ointment is applied to the wound, a chemical reaction begins, as a result of which silver ions and sulfathiazole are released. This is a gradual process, so the concentration of active substances remains at the desired level for a long time.

Silver ions have a bactericidal effect - they kill bacteria by destroying their shell.
Sulfathiazole has a bacteriostatic effect - it stops the formation of DNA in microbial cells, which is why they stop growing and multiplying.

Thus, Argosulfan® has both a bactericidal and bacteriostatic effect, acting on most gram-positive and gram-negative bacteria.

Argosulfan® cream under the dressing maintains a moderate level of moisture on the wound surface, making dressings less painful.
Stimulation of cell division and metabolic processes in them promotes wound healing and reduces the likelihood of the formation of rough scars. Advertisement RUS-DRM-ARG-NON-09-2018-1319

Publications in the media

Wound is an injury to any part of the body (especially caused by physical impact), manifested by a violation of the integrity of the skin and/or mucous membrane.

Classification • By etiology •• Puncture wound - a wound inflicted by a sharp object with small transverse dimensions (characterized by a narrow and long wound channel) •• Gunshot wound - damage to tissues and organs with a violation of the integrity of their cover (skin, mucous or serous membrane), caused by gunshot wounding projectile and characterized by a zone of primary necrosis and changes that cause the formation of foci of secondary necrosis in the surrounding tissues •• Operational (surgical) wound - a wound inflicted during a surgical operation •• Crushed wound - a wound with an extensive zone of primary traumatic necrosis, during the application of which occurred crushing and rupture of tissue •• Lacerated wound - a wound that occurs under the influence of overextension of tissue •• Cut wound - a wound caused by the sliding movement of a thin sharp object •• Chopped wound - a wound caused by a blow with a heavy sharp object; characterized by a large depth, insignificant zone of primary traumatic necrosis •• Scalped wound - a wound with complete or partial separation of a large flap of skin (on the scalp - all soft tissues) •• Bite wound - a wound inflicted by the teeth of an animal or person; characterized by infection, uneven crushed edges •• Contused wound - a wound from a blow with a blunt object with simultaneous bruising of surrounding tissues • According to pathomorphology •• Aseptic wound - a wound that practically does not contain microorganisms •• Bacterially contaminated wound - a wound containing microorganisms that do not cause (or have not yet caused) pathological changes •• Purulent wound - a wound characterized by purulent inflammation of the walls and bottom of its cavity •• Granulating wound - a wound whose cavity is filled with granulation tissue (heals by secondary intention) •• Infected wound - a wound containing pathogenic microorganisms that caused wound infection •• A poisoned wound is a wound that contains poison. Clinical picture • Pain • Gaping of the skin defect • Bleeding. Emergency care : bleeding control, pain relief, aseptic dressing, immobilization.

Treatment • Primary surgical treatment - excision of necrotic tissue and wound edges, suturing •• Fresh wounds - application of a primary blind suture •• In case of late treatment or in the presence of infection, a secondary suture is applied after cleansing the wound • Emergency prevention of tetanus . One of the following drugs is used: adsorbed tetanus toxoid (AS-toxoid), antitetanus human immunoglobulin, antitetanus serum. Complications • Traumatic shock • Blood loss • Soft tissue infection.

ICD-10. T14.0 Superficial trauma to unspecified area