Treatment of abrasion?
-Saline and antiseptic to remove debris
-Topical antibiotic and Vaseline gauze for 7-10 until re-epithelization is complete
Treatment of Incised wound
-Resuscitation if the wound is big and bleeding extensively
-Saline and antiseptic to clean wound
-Repair tendons, Nerves and blood vessels
-Simple suture and drainage only if the wound is contaminated or infected.
Treatment of lacerated wound
- Management should start by trauma life support in patients with big wounds or polytraumatized.
- Under general anesthesia, the wound is cleaned with liberal amounts of normal saline and antiseptic solution.
- All devitalized tissues and muscles should be excised until the tissues look good vascularized and bleed freshly.
- Deep important structures are repaired according to their conditions, tendons and big vessels are repaired, nerves if they can approximate easily are repaired, otherwise marked for later repair.
- Skin is closed with drainage, if possible, if there is significant loss of skin and approximation of skin edges is difficult, local skin flaps or skin grafts are used.
- In some circumstances the wound is left open for later reconstruction.
Treatment of PENETRATING WOUNDS (STAB WOUNDS)
- Management of the patient on traumatic life support bases.
- With any suspicion that the wound is extending into the visceral cavities, the patient should be explored by laparotomy or thoracotomy according to the site of wound.
- Arrest of bleeding and repair of damaged vital organs according to the nature of injury, liver repair, splenectomy, bowel repair…etc.
Treatment CONTUSION (BRUISES)
In the first 24 hours cold compresses are applied to the area to induce vasoconstriction and stop further blood extravasation
After 24 hours, warm compresses are applied to induce vasodilation and enhance absorption of extravasated blood
Treatment of hematoma
small: Left to resolve on its own
Moderate: Treated by repeated aspiration under aseptic conditions
Large: Treated by exploring area and reopening the wound and washing out the hematoma and ligating the blood vessel.
Complication of hematoma
-Infection leads to abscess hematoma
-Calcification leads to calcified hematoma
-Pressure on surrounding structures
-Opening into a nearby vein leads to traumatic arteriovenous fistula
Local factors affecting wound healing
- Growth factors: growth factors can enhance the ultimate function and appearance of the healed tissue.
- Tissue fluid (edema): edema adversely affects healing and reducing tissue fluid by raising and/or compressing the affected limb may increase the oxygen supply to the injured part.
- Blood supply is the cornerstone for proper healing without complications.
- Oxygen: Compromised oxygen supply increases susceptibility to infection.
- Infection: infection prevention requires an intact immune response of the White Blood Cells(WBC) to the local growth factors and other chemicals that are released by injured tissue, and a sufficient supply of oxygen that is used to form local oxidants, substances that destroy most of the potentially harmful bacteria in the wound.
- Radiation therapy
- Foreign bodies and prosthesis
Systemic factors affecting wound healing:
- Age: older ages have poor wound healing, and this may be attributed to concomitant medical diseases such as diabetes mellitus, malnutrition and vitamin deficiencies
- Malnutrition
- Systemic infections
- Administration of drugs e.g. Glucorticoids
- Uncontrolled diabetes
- Hematological abnormalities
ANTIBIOTIC PROPHYLAXIS
Indicated for wounds at high risk for infection:
Contaminated wounds
Penetrating wounds
Abdominal trauma
Compound fractures
Lacerations greater than 5 cm
Wounds with devitalized tissue
High risk anatomical sites—hand, foot
Function of wound dressing ?
- Maintain a sterile, moist environment.
- Absorb any discharge while preventing leakage to the dressing surface.
- Provide protection from bacteria and outside intrusions.
- Absorb wound odor.
- Allow for secure placement, flexibility, and easy removal.
- Be non-allergenic and suitable to use and change both for patients andmedical staff.
Systemic risk factors of wound dehiscence
Dehiscence is rare in patients under age 30 but affects about 5% of patients over age 60 Having laparotomy.
It is more common in patients with diabetes mellitus, uremia, immunosuppression, jaundice, sepsis, hypo albuminemia, and cancer in obese patients; and in those receiving corticosteroids.
Local risk factors of wound dehiscence
- Inadequate closure,
- Increased intra-abdominal pressure,
- Deficient wound healing.
Dehiscence often results from a combination of these factors rather than from one.
Treatment of scars?
- Since nearly all hypertrophic scars undergo some degree of spontaneous improvement, they do not require treatment in the early phases.
- If the scar is still hypertrophic after 6 months, surgical excision and primary closure of the wound may be indicated.
- Pressure garments may help flatten a potentially hypertrophic scar. Pressure should be applied early, continuously, and for 6–12 months.
- Silicone sheeting applied early and continuously for weeks or months.
- More recently, early use of the potassium-titanyl-phosphate (KTP) laser or the vascular pulsed-dye laser have been advocated to decrease scar redness as well as hypertrophy.
- Injection of triamcinolone acetonide, 10 mg/mL (Kenalog-10 Injection) directly into the lesion is the treatment of choice for keloids and intractable hypertrophic scars
- Lesions are injected every 3–4 weeks, and treatment should not be carried out longer than 6 months.
- Surgical excision and radiation therapy were the only methods of treatment of keloids.
Complication of sebaceous cysts
- Infection to form an abscess.
- Rarely ulceration and fungation (sometimes it resembles a carcinoma and is then called Cock’s peculiar tumor).
- Malignant change is rare.
- Multiple sebaceous cysts of the scalp may by pressure effects lead to baldness.
Treatment of sebaceous cyst
Complete surgical excision. If any part of the wall is left the cyst recurs.
If infected it is drained first and when the inflammation subsides, complete excision is performed.
Sebaceous adenoma and sebaceous carcinoma are rare tumors and are usually diagnosed on
histological basis after excision.
A basal cell carcinoma may arise in sebaceous and sweat glands or in the hair follicles.
Complications of lipoma
Calcification.
Infection.
Malignant changes into a liposarcoma (Common in lipomas of the shoulder region and retroperitoneal).
A submucous lipoma of the intestine may predispose to intussusception.
A subthecal lipoma, although rare may compress the cord causing paraplegia
A pedunculated submucous lipoma may undergo torsion and cause severe intestinal bleeding.
Subcutaneous lipoma
Subfascial lipoma
Uncommon lipomata
Differential diagnosis of Dermoid cyst
- Epidermoid cyst
- Encephalocele
- Lipoma
- Meningioma
- Neurofibroma
- Teratoma
- Lymphoma
- Subcutaneous abscess
- Lymphatic malformation
10.Thyroglossal duct cyst
Complications of dermoid cysts
Dermoid cysts that have intracranial or intraspinal extension may lead to:
meningitis,
abscess,
cause local mass effect.
Aspiration
biopsies of dermoid cysts have the potential to cause infection, further leading to osteomyelitis, meningitis, or cerebral abscess.
