Aseptic wounds.

Only operational wounds after planned operations or a wound after their primary surgical treatment are considered as the aseptic.

Aseptic wounds in the absence of complications heal a first intention.

Conditions for this purpose:

1) absence of an infection in a wound,

2) at linear wounds, at contact of edges and walls of a wound,

3) at suture on a wound During an adhesion of wounds, as a rule, allocate 3 phases of a current of a wound process.

The I phase – inflammations (the 1-5th days), begins at once after a trauma, is characterized by development of an inflammatory edema and leucocytes infiltration of a tissue.

In this first phase (the period of vascular changes, an inflammation phase, an exudative phase) on the foreground four factors act:

1. Changes of permeability of walls of vessels due to release of Histamine, a serotonin and other mediators of an inflammation with the subsequent exudation;

2. Migration leyko-eritro-and thrombocytes in trauma area;

3. Synthesis and a swelling of collagen fibers in the field of a wound;

4. An acidosis as a result of an anaerobic fabric exchange due to insufficiency of oxygen.

II phase of neogenesis:

In the absence of complications there is fast (48-72 hours) a beginning of neogenesis. Rapprochement and deduction of edges of a wound after its formation promotes dense comparison of tissues, their primary "gluing together" by fibrin.

The III phase – educations and reorganization of the cicatrix – begins from 15 days to 6 months.

After an suturing of an aseptic wound carry out its drainage for evacuation wound separated in a hygroscopic aseptic bandage.

The term of a removal of sutures from an aseptic wound depends on localization, the sizes of a wound, existence of local and general conditions for neogenesis.

Approximately: in a face, a neck – for 4-6 days; areas of a forward abdominal wall – 7-10 days; thorax areas, an anticnemion and foot – 10-12 days.

Treatment of the infected wounds

Tasks – elimination of the early complications menacing to life, prevention of a further becoming infected.

First aid includes: a) temporary stopping of bleeding, b) applying of a bandage, c) transport immobilization.

The help at a hospital stage: tasks – prophylaxis and treatment of wound complication, adhesion acceleration, restoration of functions of the damaged organs and tissues.

Basic principles of modern treatment: strict observance of an asepsis, a surgical treatment, an active drainage, early closing of wounds (primary and primary delayed and secondary seams, an auto skin plastic), purposeful antibacterial and an immunotherapy.

Primary seams are imposed before development of a granulation tissue, secondary – after.

In all cases the contamination of wounds (except small superficial damages) carrying out primary surgical treatment of wounds is obligatory.

The surgery field after processing is delimited sterile linen. After anesthesia by an acute scalpel excise edges of a wound from 0,5 to 2 cm within healthy tissues, delete the tissues all damaged, polluted and impregnated with a blood. If a wound chipped, it is dissected. After excising of the polluted tissue all tools replace pure, a wound delimit a fresh sterile sheet and change gloves. Further stop bleeding with layer-by-layer sew up a wound.

Primary surgical seam is applied as the final stage of primary surgical treatment of a wound on purpose:

a) restoration of an anatomic continuity of tissues

b) preventions of secondary microbial pollution of a wound

c) creation of conditions for primary wound repair