Purulent wounds

Description:

Any, accidental wound is contaminated by the microflora brought by hurting weapon or getting from clothes, the earth, skin (primary infection). If microbic flora is brought in a wound during bandagings, such infection call secondary. Species of microbic flora are extremely various, most often it is streptococci, staphylococcus, colibacillus. In rare instances there is an infection with anaerobe bacterias:

During primary contaminated wounds allocate the eclipse period, the period of distribution and the period of localization of an infection. In the first period of clinical manifestations there is no infection. Depending on a species of microbic flora it proceeds from several hours to several days. In the second period around a wound there are a swelling, redness, hypostasis, pain, the lymphangitis and lymphadenitis develop. In the third period process is delimited, further spread of an infection and absorption of toxic products to blood stops, there is a formation of a granulyatsionny shaft.

Symptoms of Purulent wounds:

The general reaction of an organism is expressed in fervescence, increase of pulse, increase in quantity of leukocytes in blood. At survey of a wound find pus. Pus is inflammatory exudate with considerable protein content, cellular elements, microbic flora, wound enzymes. At the beginning of inflammatory process pus liquid, further dense. The type of pus, a smell, color depend on the microbic flora which caused inflammatory process. Eventually in old purulent cavities microbic flora in pus disappears or loses the virulence.

Prevention of purulent wounds:

For anybody not a secret that in time not debrided wounds, grazes and scratches lead to hit of infections in fabric. Processing is important for all, with special care it is necessary to approach processing of wounds when business concerns the child. Children quite often become grazes and cuts, danger of such injuries is covered not only in a pain syndrome, but also in features of use of means on children's skin therefore the correct antiseptic processing - the most important point in treatment. However before parents often there is a question, than to process the burning wound covered with blisters at the same time to recover the damaged fabrics, to relieve pain and at the same time to reach the desirable disinfecting effect. Brilliant green and iodine are a last century, to that these means are too aggressive for the gentle children's skin inclined to diathesis and irritations. Therefore modern pediatricians recommend to use antiseptic drugs on the basis of silver salts, such as Sulfargin. This means accelerates healing process, reliably protects from bacteria and is safe for sensitive skin.

Reasons of Purulent wounds:

Pathogenicity of microbic flora, impurity of a wound, long gyrose the wound channel, existence of a hematoma, numerous cavities, bad outflow from a wound belong to the factors promoting development of an infection in a wound. Exhaustion, decrease in an immunoreactivity negatively influence the course of inflammatory and purulent process. The infection remains the wound limited to limits during the first 6-8 h. Microbes and their toxins extend on lymphatic ways, causing an inflammation of absorbent vessels and nodes. At the developing suppuration reddening of integuments, a swelling of edges of a wound, sharp morbidity at a palpation are noted.

Treatment of Purulent wounds:

Treatment of purulent wounds consists of two directions - topical and general treatment. The nature of treatment, besides, is defined by a phase of a wound process.

Topical treatment of purulent wounds
a) Problems of treatment in an inflammation phase
In the first phase of a wound process (an inflammation phase) the surgeon is faced by the following main objectives:
• Fight against microorganisms in a wound.
• Ensuring adequate drainage of exudate.
• Assistance to the fastest clarification of a wound from necrotic fabrics.
• Decrease in manifestations of inflammatory reaction.

At topical treatment of a purulent wound use methods of the mechanical, physical, chemical, biological and mixed antiseptics.

At suppuration of a postoperative wound usually happens to remove enough seams and to widely part its edges. If these actions are not enough, then performance of the secondary surgical treatment (SST) of a wound is necessary.

b) Secondary surgical treatment of a wound
The indication to VHO wounds are existence of a suppurative focus, lack of adequate outflow from a wound (a pus delay), formation of extensive zones of a necrosis and purulent zatek. As a contraindication serves only critical condition of the patient, at the same time are limited to opening and drainage of a suppurative focus.

The tasks facing the surgeon who is carrying out wound VHO:
• Opening of a suppurative focus and zatek.
• Excision of impractical fabrics.
• Implementation of adequate drainage of a wound.

Before VHO it is necessary to determine visible borders of an inflammation, localization of area of purulent fusion, the shortest access to it taking into account a wound arrangement, and also possible ways of spread of an infection (by the course of neurovascular bunches, muscular and fascial vaginas). Except a pallatorny research in this case different types of tool diagnosis are applied: an ultrasonic method, thermographic, x-ray (at osteomyelitis), a computer tomography.

As well as primary surgical treatment, VHO is an independent operative measure. It is carried out in the operating room, team of surgeons with anesthesia use. Only adequate anesthesia allows to solve all problems of VHO. After opening of a suppurative focus careful tool and manual audit on the course of the wound and possible finding of zatek which in the subsequent also open through the main wound or counteropening is carried out and drain. Having executed audit and having determined necrosis volume, make evacuation of pus and excision of impractical fabrics (necretomy). At the same time it is impossible to forget that close or in the wound there can be large vessels and nerves which need to be kept. Before the end of operation the cavity of a wound is plentifully washed out by antiseptic solutions (hydrogen peroxide, boric acid or other), рыхло is tamponed by gauze napkins with antiseptic agents and drained. The most favorable way of treatment at extensive purulent wounds is flowing and washing drainage. In case of localization of damage on an extremity the immobilization is necessary.

c) Treatment of a purulent wound after operation
After performance of VHO or simple disclosure (opening) of a wound on each bandaging the doctor examines a wound and estimates its condition, noting dynamics of process. Edges are processed by alcohol and iodinated solution. The cavity of a wound is cleared by a gauze ball or a napkin of pus and freely lying sequestered sites of a necrosis, necrotic fabrics are excised by an acute way. Then washing by antiseptic agents, drainage (according to indications) and friable packing follows.

Treatment purulent ranpr pancreatitis is surprised one of the major bodies – a pancreas at which there are most severe pains. The pancreas helps to digest fats, proteins and carbohydrates in intestines, and hormone insulin regulates glucose level in blood. Pancreatitis arises because of – obstruction of a gall bladder or a channel of the gland, an infection, helminthosis, an injury, an allergy, poisoning, the use of often alcoholic drinks. The main component of treatment of a pancreas a diet at which the first two-three days it is necessary to starve. Also it is necessary to exclude after treatment greasy, fried and spicy food, alcohol, acid juice, strong broths, spices, smoked products. The diet begins about 4 days, at the same time is not less than 5-6 times a day in the small portions are possible. During a diet it is better to eat some grades of fish, meat, not strong cheese, fresh low-fat cottage cheese. Fats need to be reduced to 60 g a day, having excluded mutton and pork fat from a diet. Limit sweet and carbohydrate products. Food has to be always warm at the use. Thanks to all this there is a recovery of a pancreas. And in order that pancreatitis did not arise again, follow all advice which is written above.


In the first phase of healing when there is plentiful exudation, it is impossible to use ointment drugs as they create an obstacle to outflow separated in which there is a large number of bacteria, products of proteolysis, necrotic fabrics. During this period the bandage has to be most hygroscopic and contain antiseptic agents. Can be them: 3% solution of boric acid, 10% solution of sodium chloride, 1% solution of a dioxidin, 0,02% solution of a hlorgeksidin, etc. Only for 2-3 days use of water-soluble ointments is possible: Levomekol, Levosin, Levonorsin, Sulfamekol and 5% dioxydinew ointment.

In treatment of purulent wounds "the chemical necretomy" by means of the proteolytic enzymes having nekrolitichesky and antiinflammatory effect has a certain value. Trypsin, chymotrypsin, chemical opsin are for this purpose used. Drugs are filled up in a wound in a dry form or entered in solution of antiseptic agents. For active removal of purulent exudate directly in a wound stack sorbents, the most widespread of them is Polyphepanum.

For the purpose of increase in efficiency of VHO and further treatment of purulent wounds in modern conditions apply various physical methods of influence. Ultrasonic cavitation of wounds, vacuum processing of a purulent cavity, processing by the pulsing stream, various routes of administration of the laser is widely used. All these methods pursue the aim of acceleration of clarification from necrotic fabrics and pernicious impact on microbic cells.

d) Treatment in a regeneration phase
In a regeneration phase when the wound was cleared of impractical fabrics and the inflammation abated, start the following stage of treatment which main objectives are suppression of an infection and stimulation of reparative processes.

In the second phase of healing the leading role is played by process of formation of granulyatsionny fabric. In spite of the fact that it bears also protective function, completely it is impossible to exclude a possibility of a repeated inflammation. In this period in the absence of complications exudation is sharply reduced also need for a hydroscopic bandage, use of hypertonic salt solutions and drainage disappears. Granulations very gentle and vulnerable therefore there is necessary a use of drugs on the ointment basis interfering mechanical traumatization. Also the antibiotics (sintomitsinovy, tetracycline, gentamitsinovy ointments, etc.) stimulating substances enter into composition of ointments, emulsions and linimentums (5% and 10% metiluratsilovy ointment, Solkoseril, "Actovegin").

Multicomponent ointments are widely applied. They contain the antiinflammatory, stimulating regeneration and improving regional blood circulation substances, antibiotics. Levometoksid, "Oxyzonum", Oksitsiklozol, balsam linimentum according to A. V. Vishnevsky treat them.

For acceleration of healing of wounds the technique of imposing of secondary seams (early and late), and also tightening of edges of a wound is used by an adhesive plaster.

e) Treatment of wounds in a phase of education and reorganization of a hem
In the third phase of healing acceleration of epithelization of a wound and protection it from excessive traumatization becomes the main objective. Bandages with the indifferent and stimulating ointments, and also physiotherapeutic procedures are for this purpose used.

e) Physiotherapeutic treatment