Wound (vulnus) — is the mechanical harm to the integrity of the pores and skin or mucous membrane. Wounds belong to essentially the most usually accidents in struggle and peace time. The issue of wounds therapy is likely one of the major and in keeping with its situation the conclusion in regards to the degree of drugs growth is made.
The medical image of a wound is decided by native (infringement of the integrity of tissue, gaping of wounds, bleeding and ache) and normal attributes (acute anemia, shock, an infection).
There are totally different classifications of wounds. After the character of a dangerous agent the next sorts of wounds are distinguished:
Reduce wounds — attributable to a pointy object, linear-shaped andcharacterized by gapes, even edges and plentiful bleeding.
Chopped wounds — attributable to a pointy huge object such asa sabre, axe and in contrast to to incision wounds they’re accompanied by contusion and smashing of sentimental tissue.
Contused wounds are attributable to a blunt object or happen duringa fall and the compression of tissue, characterised by uneven jagged edges and important injury of the encompassing tissue.
Smashing and lacerated wounds are characterised by necrosisof delicate tissue, regularly contaminated, insignificant bleeding.
Pricked wounds end result from a prick by a pointy object, damageto delicate tissue is insignificant, however due to the depth the important organs may be injured — the guts, the big vessels, the lungs.
Gunshot wounds are the results of the actions of a bullet ormissile splinters; regularly accompanied by harm to massive vessels, nerves, important organs, thus the mix of two damaging components is noticed: mechanical and thermal; heavy types of purulent, anaerobic infections regularly develop in fireplace wounds.
Bitten wounds are the results of human or animal bites, it regularly suppurates; animal bites may cause rabies or rat sickness.
Poison wounds kind on account of toxic snake or scorpionbites or toxic army substances getting into the wound or industrial poisons.
Excoriations and scratches are essentially the most superficial injury totissue, and have a positive course.
Blended wounds are wounds which had affect of poisonousmilitary substance or radiation; radiation trauma is regularly mixed with the radiation sickness growth.
After the explanations of harm the injuries are divided into operational and unintended. Relying upon the cavities of the physique the injuries are divided into penetrating and non-penetrating (with or with out injury of inside organs). After the anatomic options the injuries are subdivided as follows: wounds of sentimental tissue, the injuries with injury to vessels, nerves, tendons, inside organs. After the variety of damages to 1 affected person wounds are divided into single and a number of. Injury to a number of organs bordering two or a number of anatomic websites are thought of as mixed trauma.
It’s doable to categorise wounds by their anatomic localization: wounds to the neck, head, hips, thorax, abdomen, and many others.
The spreading of wounds in keeping with the extent of an infection has particular worth — aseptic and contaminated. Solely postoperative wounds are thought of as aseptic. Different wounds are thought of contaminated, as a result of in the mean time of injuring the microorganisms could possibly be on the pores and skin or on the injuring object. The event of wound infections is accompanied by many medical signs of normal and native character. The earliest normal signs are deterioration within the affected person’s well being situation and a rise within the physique temperature. The character of the temperature curve relies upon upon the organism’s response and virulence to infections, massiveness of an infection and abundance of the method, delay in pus discharge, prevalence of latest purulent cells. Generalization of an infection is accompanied by hyperthermia and a change within the character of the temperature curve. An necessary symptom is fever, linked to the huge entrance of microbes into the blood, their toxins and merchandise of tissue disintegration. Fever testifies to the presence of un-drained purulent cells, the looks of putrefactive infections or the septic situation of the affected person.
The progressing of an infection within the wound is accompanied by infringement of the perform of the nervous system (headache, sleeplessness and inhibition), cardiovascular system (tachycardia, disturbances of the cardial rhythm), respiratory system (dyspnea, shallow respiration). Pulse acceleration with decreased physique temperature is an hostile symptom which testifies of progressing infections in wounds and a lower in immune safety. Infringements of the liver perform (particularly desintoxication) and the kidney perform (albuminuria, oliguria) are marked. The affected person complains of dryness within the mouth, nausea. Adjustments of the final character are expressed to totally different extent. With gentle types of banal purulent an infection in wounds they’re insignificant, in extreme instances the endotoxic shock, which might trigger the dying of the affected person, develops.
Native adjustments within the wound rely each upon the diploma of posttraumatic destruction of tissue and the exercise of the microbic flora. The best adjustments are marked in smashing-lacerated wounds and gunshot wounds.
Normally a day after bacterial air pollution of the wound, a pyoinflammatory course of seems exactly. The underside of the wound and its contents will get dirty-grey, the perimeters of the wound are dense and swollen. The pores and skin beneath the hypostasis zone turns into hyperemic, scorching when touched and painful throughout palpation.
Ache within the wound amplifies with infringement of discharge outflow (pulsating ache). The wound excretion, its colour, scent, consistence, quantity rely upon the form of microbic agent. Necrotic tissue within the preliminary part of irritation is often densely fastened to the underside and edges of the wound, their quantity in the course of the hostile course of the method can develop resulting from secondary necrosis. Aggrevation of irritation indicators (ache, hypostasis, and hyperemia) are hostile prognostic signs and testify to the progress of a purulent course of.
In case of a positive wound course of course, 3–5 days after the trauma, inflammatory demarcation of nonviable tissues, which then reject and lysed within the wound, happens. On the similar time, clearing of the wound from microbic flora takes place. The inflammatory response regularly ceases, the wound course of passes into the interval of reparation with medical attributes of the granulation tissue look within the wound. Wholesome granulations are bright-pink, their floor is shiny, simply bleeds with insignificant injury. Infiltration of the perimeters of the wound is significantly diminished, discharge from the wound, which turns into serous, decreases. Granulation tissue is the morphofunctional barrier (granulation roll), created on the wound web site in opposition to dangerous environmental affect. Wholesome granulation tissue prevents the penetration of an infection, diffusion of poisons and merchandise of tissue disintegration, limits the lack of proteins and ions.
Disturbance of the character of granulations (languid, cyanotic or grayish-red), lower of their development, and enhance within the quantity of wound discharge are extraordinarily hostile indicators. They’re proof of the activation of main wound florae or the presence of superinfection, in addition to a lower within the immune standing. The chance of generalization of an infection (sepsis) will not be excluded. Scientific image of harm of the granulations barrier perform is in enhance within the quantity of the native inflammatory course of with a renewal of pyoresorption fevers (deterioration of well being situation, enhance of ache within the wound, left shift leukocytosis, lymphopenia, enhance within the leukocytic index of intoxication, acceleration of the erythrocyte sedimentation price — ESR).
With the intention to select the right therapy coverage of wounds, the surgeon ought to accurately estimate the character of harm, part of the wound course of. The wound course of is a set of organic phenomena which persistently develop within the wound. The pathogenesis of the wound course of depends upon the phase-like course, unity of particular person phases and transition of 1 part into one other one. Even supposing quite a few works are dedicated to the examine of the wound course of pathogenesis, a normal classification of the wound course of will not be established but. Probably the most widespread ones are the next.
For a very long time in medical follow I. G. Rufanov’s (1954) classification prevailed. In accordance with this classification the wound course of course consists of two phases:
I part (part of hydration) — transition of gel into sol, cleaning of useless tissue from the wound;
ІІ part (part of dehydration) — granulation, tissue regeneration.
For the final years amongst medical physicians the most well-liked is G. I. Kuzin’s classification (1977), in keeping with which three primary phases of the wound course of course are distinguished.
I part — irritation, subdivided into two durations — the interval of adjustments and interval of purification of the wound from necrotic tissue;
ІІ part — regeneration or proliferation — granulation tissue formation;
ІІІ part — reorganization of the scar.
The primary part of acute irritation, or hydration, is characterised by hyperemia of the wound tissue, blood vessels dilating and their permeability disturbances. Stasis and thrombosis in vessels are noticed. Tissue is saturated with liquid, there may be a lot wound discharge.
Metabolism dysfunction is noticed within the wound, processes of cardio and anaerobic glycolysis prevail. In consequence, the quantity of insufficiently oxidized merchandise of metabolism (lactic, pyroracemic acid) will increase within the wound, acidosis happens. There’s a relative discount within the quantity of calcium, however the quantity of potassium, carbon dioxide in addition to tissue hypoxia will increase.
Leukocytes and phagocytes migration amplifies; the discharge of necrotic tissue, toxins and disintegration merchandise begins. That is promoted by the phagocytal and fermental exercise of cells. Autoand heterolyzates additionally participate within the autolysis processes. Scientific adjustments are noticed within the wound: ache, swelling, infiltration, rise of temperature, infringements of organ features.
Within the second part — regeneration — regenerative processes prevail, exudatation is diminished. Subsequently this part can be referred to as dehydratation.
Blood circulation improves in tissue and the contents of oxygen will increase, hydroxyl ions and calcium enhance, the quantity of hydrogen ions and potassium decreases.
Subsequently metabolism is normalized and acidosis is diminished. The opening of the wound is full of younger connective tissue; cicatrix begins to kind. With the start of dehydration, the ache, temperature, swelling and infiltration lower. The wound is cleansed from wound discharge and necrotic tissue, granulation tissue is fashioned in it and there are attributes of epithelization of the wound edges. Clinically these phases are divided one from one other not so exactly. It’s doable to watch regularly the processes attribute for each phases. Nonetheless, the prevalence of a corresponding course of permits a medical doctor to confirm the part and appoint corresponding therapy.
Any injury to the tissue causes a fancy of biochemical reactions each within the wounded cell and in several organs and techniques of the whole organism.
The idea of metabolism of the wound course of is infringement of metabolism, ensuing from a trauma. The earliest show of response to a trauma is a rise within the permeability of capillaries, which allows albuminous elements of plasma to penetrate into the intravascular house, which causes infiltration of the injured tissue and blockade of vitamins and oxygen getting into into the intercellular house and cells. Subsequently, the earliest infringement of metabolism within the wounded cell is the transition to anaerobic sort of glucose decomposition.
In early phases there’s a lower within the respiratory issue, enhance in anaerobic glycolysis and autolysis of tissue. Anaerobic glycolysis is the power supply, essential for growing wound inflammations, processes of biosynthesis, linked to regeneration of mobile components and tissue. Thus glucose is actively used and lactic acid collects, subsequently there may be acidic shift (pH). A rise in acidity within the wound is precipitated not solely by the rise in formation of lactic acid and different natural acids of the Krebs cycle, but in addition the congestion of blood circulation within the dilated vessels which causes the congestion of carbonic acid.
Underneath the circumstances of an acidic medium tissue change is damaged, osmotic strain will increase, the exercise of fermental processes adjustments. With acidic response bactericidal properties of tissue colloids reasonably enhance. A major lower in рН, linked with intensive infectious-inflammatory course of within the wound, will get a damaging worth — important exercise is damaged and cells die.
The event of wound irritation and the injury of tissue ends in the buildup of potassium in tissue. A rise of the contents of potassium within the wound exudate, lymph and blood ends in the infringement of the conventional ratio of electrolytes (sodium, potassium, calcium). A sure relation between the expansion of the focus of Н-ions, potassium ions and the depth of pyoinflammatory course of is marked. When the irritation begins reducing, the contents of potassium, sodium and chlorides lower, and the focus of calcium will increase. For every part of the wound course of, a rise within the exercise of sure teams of enzymes, particular to the sure interval of therapeutic, is typical. For instance, the part of wound irritation begins due to vascular response, throughout which vasoactive substances enhance together with proteolytic enzymes.
The extent of vasoconstrictor substances (dofamine, noradrenaline, adrenaline, kinin) is regulated by transferase, and their surplus is neutralized by monoaminooxydase.
Roughly 6–9 h after injury to the central zone of the wound focus necrotization of tissues and cells, the early attribute of which is the discount or disappearance of enzyme exercise, begins.
A rise in enzyme exercise within the wound happens not solely because of the activation of enzyme techniques, but in addition on account of enhance of enzymes focus, which come from blood plasma, migrating leukocytes and native mobile components. A large amount of enzymes, which promote the destruction and removing of elements of tissue disintegration from the wound launch from granules within the extracellular house with the destruction of neutrophilic leukocytes. On the similar time, in one-nuclear cells the excessive exercise of glucose-6phosphate dehydrogenase is marked, which is the preliminary stage of the pentosophosphate cycle, linked with phagocytosis and the antibacterial motion of oxidizing reactions. The regeneration part begins with the epithelium cells migration. Power for this course of to a sure extent relies upon upon the ATPase enzyme exercise. The mitotic response is all the time preceded by the activation of DNA synthesis. A rise in mitotic exercise is accompanied by a rise of oxidation within the citric cycle with the participation of oxidoreductase. The fibroblasts, liable for the synthesis of polysaccharides and collagen, have the maximal exercise within the regeneration part.
Within the reorganization part (formation of a scar), which begins roughly on the twelfth–14th day of the wound course of, the exercise of nearly all of enzymes is diminished, after which fully stops. Thus, adjustments in metabolism in the course of the therapeutic course of are expressed by several types of enzyme reactions of catabolic and anabolic character.
Scientific image classification of the wound course of bases on the medical standards, which mirror the essence of every part (B. M. Datsenko and co-authors, 1995). In accordance with this three consecutive phases: purulent-necrotic, granulation tissue, new epithelium are distinguished.
Wound therapeutic is a regenerative course of that displays the organism’s response to trauma. Therapeutic course of is influenced by many components.
Wound regeneration is slowed down on account of injury to blood vessels and nerves, the presence of blood clots and international our bodies, necrotic tissue, resulting from growth of virulent microflorae. Normal components affect negatively the therapeutic course of: insufficiency of the liver and renal perform, hypovitaminosis, diabetes, deficiency of organism’s immune safety.
There are two sorts (main pressure and secondary pressure) of therapeutic.
The next circumstances are essential for main therapeutic: clean viable wound edges, their dense cohesion, absence of international our bodies within the wound, necrosis cells and microflora.
Secondary therapeutic is noticed when there aren’t any circumstances for main therapeutic: presence of necrosis of the wound edges, gaping, clots, and international our bodies. Wound microflora performs an necessary position. Secondary therapeutic is characterised by pyesis and granulation tissue formation. Within the part of acute irritation, or hydration, processes of alteration prevail within the wound, suppuration takes place. The wound is full of pus, the perimeters are swollen, hyperemia, there are cells of necrotic tissue, solely single websites of granulation, which seem principally on the third, typically eighth–tenth day are noticed.
Pus is inflammatory exudate, which comprises neutrophilic leukocytes, micro organism, stays of destroyed cells. Relying upon the form of microflora the colour, consistence and quantity of purulent excretion change. For wound therapy the bacteriological investigation of the purulent exudate (launch of unpolluted tradition and definition of antibiotic sensitivity to microflora) have nice worth. A major quantity of granulation tissue often seems within the second part — throughout regeneration (dehydration). Its formation is predetermined by a rise within the development of blood capillaries, which, reaching the wound edges, don’t join like with main pressure therapeutic, however kind loops. Within the loops of capillaries, fibroblasts are positioned, which resulting from intensive division, produce collagen fibers. On the similar time epithelizaiton of the wound edges happens.
Six layers are distinguished within the granulation tissue at histologic examination. The superficial leukocytic-necrotic layer comprises leukocytes, mobile detritis and microbes. Underneath this layer, the layer of vascular loops is situated, the place there’s a important quantity of polyblasts and collagen fibers. The third layer is the layer of vertical vessels (fibroblast, amorphous intermediate substance). The next three layers: maturating layer, layer of horizontal fibroblasts and fibrous. The idea is the layer of the mature fibrous connective scar. The granulation tissue is a barrier that separates the interior medium of an organism from exterior affect. It is rather delicate, weak mechanical trauma (rubbing by a gauze tampon) causes its injury and bleeding.
On the third part of therapeutic there may be reorganization of the connective tissue scar (fibrosis tissue) and processes of epithelizaiton and therapeutic come to an finish.
With secondary therapeutic a large and uneven scar is fashioned. Typically it turns into keloid-dense, thickened, painful, will get purple. The rationale for keloids formation is neutrophic and endocrine issues, insufficiency of native blood circulation. Incessantly ulcers, which don’t heal for a very long time and might change into malignant in some instances, develop on the keloid scar.
Quite a lot of strategies of goal estimation of the wound course of course are utilized within the medical follow. A change within the sizes of the wound may be supervised by planimetric strategies. The sizes of a wound are measured with the assistance of sterile cellophane which outlines its contours (L. M. Popova’s technique) or polyethylene (T. P. Ziryanov’s technique). Bacteriological management over the course of the wound course of is compulsory and consists of the dedication of the form of pathogenic organism, its sensitivity to antibiotics and quantitative estimation.
The best technique of figuring out the pathogenic organism with the assistance of bacterioscopy in smears-prints of the wound exudate with the coloring by Romanovsky—Gymsa. To get a full thought of microorganisms within the purulent wound, it’s essential to research not solely the prints but in addition to make inoculation of the medium. It makes doable on the similar time to establish deep microflora and decide the quantity of pathogenic organisms in 1 g of tissue (degree of bacterial insemination).
The extent of bacterial insemination within the wound is an important parameter within the physician’s follow as a result of it permits to objectively estimate the qualities of surgical therapy, make prognosis of the course of the pyoinflammatory course of, management the phrases of placing in secondary stitches, conduct comparative estimation of the effectivity of various medicamentous means, that are utilized for the native therapy of wounds. As a rule, efficient surgical therapy of the wound ends in a lower within the degree of bacterial insemination of the wound (102–103 by 1 g of tissue). The rise within the quantity of micro organism within the wound (105–106 by 1 g of tissue) is an hostile signal and testifies to sepsis growth.
With the intention to decide the antibiotic sensitivity of microflora, often a disk antibioticogram inoculation on the Petri’s cup with agar with the next software of ordinary paper disks moistened with options of various antibiotics are used. Microbes are thought of immune to the examined antibiotic if the zone of development inhibition is lower than 15 mm, delicate — if the zone of inhibition is from 15 as much as 25 mm and extremely delicate if this zone is over 25 mm.
Cytologic examination of the wound exudate has an necessary diagnostic worth and characterizes the adjustments within the construction of mobile components of the wound exudate relying upon the part of wound course of and the character of therapeutic.
Clinically, the strategy of wound prints in keeping with G. P. Pokrovska — M. S. Makarov and the strategy of superficial biopsy of the wound in keeping with G. F. Kamayev are widespread. Each microflora, and mobile components (leukocytes, connective tissue cells, and epithelium and the character of phagocytosis within the wound are taken under consideration within the cytogramm. Different strategies are utilized to review the wound course of: the strategy of colour thermography, the polygraphic technique of defining partial strain of gases, the electrothermometry technique, the strategy of examination of wound electropotentials, the ultrasonic echolocation technique. With the assistance of the echolocation technique it’s doable to find out the stage of inflammatory course of. The quantitative strategies of controlling the course of the wound course of permits to objectively estimate totally different strategies of purulent wounds therapy.
Remedy of wounds is carried out with considering the organic processes, which occur. The aim of therapy is to resume the first kind and performance of the injured organs and tissue. The therapy of aseptic and purulent wounds is totally different. When treating aseptic wounds, the primary demand is relaxation for the injured web site and preventive measures of getting into and growing an an infection (portray the perimeters of the sutured wound with options of iodine, iodonatum, jodopyronum, spirit and shutting it with a sterile gauze bandage, it’s doable to use antiseptic aerosols which harden on the injuries as a protecting). With in depth postoperative wounds with a view to cease lymphorrhea and bleedings within the opening in some instances lively drainage of the wound is utilized (in keeping with Redon or the three-ampoule system).
All unintended wounds are contaminated. First support for contaminated wounds consists of making use of aseptic isolating bandage for preventive measures of subsequent an infection throughout transportation, stoppage of bleeding (compression bandage, making use of a tourniquet and using antishock actions — introduction of analgetics, medication). Specialised assist for these wounds consists of an operation with main surgical debridement of the wound (PSD) inside first 48 h after the harm. The perfect outcomes of PSD are carried out in the course of the first 8 h after the harm.
Theoretically and experimentally finishing up PSD was confirmed by O. O. Tcharukovsky (1836) and P. Fridrikh (1898). The aim of PSD is to stop the wound an infection and create favorable situation for therapeutic by remodeling any wound right into a incised wound and its suturing for main therapeutic. PSD can embrace the next elements: bathroom of the wound, suturing of the injuries, eradicating nonviable tissue, eradicating international our bodies, haemostasis, and renewal of damaged anatomic tissue interrelations. The phrases for performing PSD have primarily nice worth; it ought to be executed as quickly as doable. Relying upon the time period of the PSD efficiency it may be: early — the primary day after the wound, delayed — the second day, and late — after 48 h. After therapy of the operational discipline and anaesthesia, the perimeters, partitions and backside of the wound they incise with a scalpel; take away all broken tissue, international our bodies, rags, bone fragments and clots of blood that are free. After incision off the polluted and necrotic tissue, instruments and gloves are modified, cautious haemostasis and suturing the wound by layers is carried out.
PSD on totally different websites of the physique have totally different peculiarities. They don’t incise the vessels, nerves, or periosteum. They spare the muscle mass as a lot as doable, deleting solely nonviable websites (darkish, which don’t contract with irritation by tweezers, don’t bleed). It’s essential to watch out when treating broken tendons. Joint cavities are closed. It’s essential to empty the injuries, particularly the deep ones. Late surgical debridement (after 48 h) consists in easy cleaning the wound from grime, items of the item which wounded, international our bodies and removing of necrotic tissue. They don’t incise the tissue inside the limits of wholesome websites. They incise and drain recesses, contaminated hematomas and abscesses, present circumstances for drainage of wound discharge.
Closing the wound and renewing the damaged anatomic interrelations completes PSD. Relying upon the phrases of conducting operation, there are totally different sorts of positioned suturs. If PSD is carried out in the course of the first 8 h after the trauma, main suturs are imposed. The wound ought to be closed beginning with the deep layers so as to not kind free cavities, the place excretion can accumulate. At suturing of deep wound it’s essential to enter a rubber or polyvinylchloride tube into it for antibiotic lavage and at any time when doable create lively aspiration of the wound discharge (rubber bulb, and many others.). With late phrases of finishing up PSD (after 24–48 h) and the presence of contraindications regarding inserting main sutures (hazard of growing anaerobic infections) a retention suture is positioned or they clear up the issue about inserting delayed sutures — main or secondary sutures.
The first delayed suture (tied or retention suture) is imposed on third–fifth day after PSD if there isn’t any wound abscess.
Early secondary sutures are positioned with the presence of infectious problems within the wound in 8–15 days with the disappearance of irritation, the event of granulation tissue. They’re positioned on a granulating wound with out incising the granulations.
Late secondary sutures are positioned in later phrases (15–25 days) when there may be granulation and scar tissue, and the therapeutic of wounds happens slowly. Incision of the perimeters of the wound and the scar tissue of all depth (secondary surgical debridement) is carried out earlier than suturing.
The ideas of native therapy of purulent wounds ought to correlate with the stage of the wound course of. Within the first part of irritation (hydration) hypertonic options of various antiseptics, which have dehydration impact (10% resolution of sodium chloride, 25% resolution of glucose, 30% resolution of urea, and 1–5% resolution of boric acid) obtain extensive software.
Proteolytic enzymes (trypsinum, chymopsinum, chymotrypsin, terrilytin, elastomesenterasa, and many others.), which have pronounced necrotic, inflammatory motion, cut back antibiotic stability and virulence of microbes within the wound, additionally obtain extensive software. Final years, immobilized proteolytic enzymes (linked to the tissue matrix that provides a possibility to create their fixed focus in a wound) are extra broadly utilized. With the intention to battle with an infection within the wound, antibiotics are utilized with considering account the antibioticogram and sensitivity of a affected person’s organism. It’s essential to want antibiotics that are entered immediately into the wound (gramicidin, polymyxin, chloramphenicol, and many others.).
With antibiotic-resistant strains, reserve antibiotics (cephalosporins, thienam, and many others.) in addition to such antiseptics as ethonium, chlorhexidine, rocal, dioxydine, sulfamilon, chlorophylipt, furagin, solaphur are often utilized final 12 months. Water-soluble ointments with a polyethylene oxide foundation — levosin, levomycol, dihydroxycol, 10% ointment of acetate mafenid, iodopionic ointment, haniphurin — meet the necessities of complicated motion within the first part of the wound course of. Polyethylene oxide types complicated compounds with antimicrobic preparations, rising 20–60 instances their motion and offering their penetration into the depth of the broken tissue. Within the first part medicamentous therapy is broadly supplemented with bodily strategies of therapy: lively draining the wound, laser remedy, therapy in gnotobiologic isolators, software sorption (carbon sorbents or non-tissue carbon supplies positioned on the wound), ultrasonic irradiation of wound, solux, diadynamical currents, magnetotherapy, ionophoresis with totally different antiseptics and regeneration stimulators.
Within the second part of the wound course of, native medicamentous remedy ought to be directed on the stimulation of regenerative processes, safety of granulation tissue from injury and prevention of reinfection of the wound with hospital an infection. With this goal, vanillin, dogrose oil, ointment on a vaseline-lanolin foundation with antibiotics, olasol-methyluracil ointment obtained extensive software. It’s doable to use Vishnevsky ointment. Efficient stimulators of the regeneration course of are such preparations as combutecum, alginor. Within the third part of the wound course of, the identical remedy as for the second is utilized.
Medicamentous remedy prevails with the therapy of small wounds. With the therapy of huge wounds, medicamentous remedy is mixed with surgical therapy and fashionable bodily strategies.
Whereas treating wounds, strategies of normal motion on the organism in sufferers with endotoxicosis, infringements of the immune standing and homeostasis have nice worth.
Immunotherapy of wound an infection ought to be carried out in keeping with concrete parameters of the immune standing and ought to be directed on replenishing the deficiency of sure elements of immune safety.
Passive (substitute) and lively immunotherapy are distinguished. The transfusion of fresh-citrate donor blood, introduction of hyperimmune plasmas (antistaphylococcal, anti-blue-pus), particular antibodies (antistaphylococcal, anti-blue-pus, anti-influenzal), bacteriophage, leukocytic mass, interferon are utilized as substitute immunotherapy.
For lively immunotherapy, the introduction of auto-vaccinations (product of wound microflora), staphylococcal anatoxin, totally different immunodepressants. As artificial immunomodulating components, levomysol (decaris), prodigiosan are utilized. Pure immunomodulating components, obtained from the thymus of an animal (tactivin, thymalin, thymogen, timosin) or from the bone marrow (B-activin or myelopeptide) are extra particular.
Homeostasis correction is of nice worth — normalization of protein metabolism (high-caloric eating regimen, protein preparations and blood substitutes, anabolic hormones).
For correction of endotoxicosis, which develops with generalized an infection, strategies of extracorporate cleansing of an organism, which neutralizes toxins within the blood or lymph, have lately obtained extensive software. They’re haemosorption, plasmosorption, plasmapheresis, lymphosorption. They’re utilized, principally, with hepatic insufficiency growth. With acute renal insufficiency growth in opposition to a background of wound an infection, haemodialysis, haemofiltration, haemodiafiltration are utilized.