A wound is a damage to a tissue or organ resulting from a mechanical impact. The victim forms a violation of the integrity of the skin or mucous membranes on the body. To determine the injury is very simple by the characteristic signs - bleeding, pain, divergence of the edges.
The human body is a fragile system that is daily exposed to various traumatic effects. Damage can be obtained literally in any life situation, for example, during cooking (cuts, burns), or driving, so all of them are classified and grouped, including, to systematize treatment methods.
Basic classifications of wounds
Damage and damage to the skin and mucous membranes can have a different nature of appearance, different manifestations and depth of affecting the skin membranes and mucous tissues. Thus, penetrating wounds are injuries that are accompanied by the destruction of the integrity of the peritoneum, pleura, joint membrane, walls and cavity of internal organs. Non-penetrating, in turn, do not affect the abdominal membranes.
Wounds can also be postoperative, for example, after abdominal surgery and laparoscopy, or accidental, which were obtained as a result of an accident.
Depending on whether there is a purulent infectious process in the wound bed, it may be infected, contaminated (if there are no signs of suppuration in the wound), or aseptic, that is, resulting from a “clean” operation.
If we talk about the method of obtaining injuries and the type of injuring object, physicians distinguish between stabbed, cut, chopped wounds, injuries of the hurt type, torn and bitten. In addition, a wound can be a gunshot if it appears after exposing the human body to a firearm.
According to the degree of wound penetration into the body, the most innocent are superficial, that is, literally affecting the top 2-3 millimeters of the skin. Deep wounds reach more than a few centimeters deep. The tangential type of injury implies that the fabric is cut off as a subject of injury. The wound has an outlet through which the object leaves the body.
Blind wounds are formed if a traumatic object, such as a bullet, remains in the body, getting stuck in tissues, organs, bones. Such lesions do not have an outlet. Through wounds, on the contrary, are characterized by the presence of two holes on the body - input and output. The wounding object leaves the body on its own.
Treatment of various types of wounds, use of dressings
To determine the presence of a wound in a person is quite simple - usually this damage is accompanied by pronounced pain, bleeding. If the blood vessels are affected, the affected person has a strong blood loss, and the blood can ooze, flow, or be a pulsating jet. The wound diverges the edges, exposing the inside of the trunk, limbs or head. In some cases, the pain can be so severe that a person develops a painful shock.
Wound treatment begins mainly with first aid to a person. To do this, you must first determine the type of injury, its degree and depth. If the victim has bleeding, it should be stopped as soon as possible to prevent abundant blood loss. One way to stop bleeding is to apply a pressure bandage.
However, the implementation of the dressing is important not only at the stage of first aid. In medical practice, experts distinguish two types of wound treatment:
- with bandages;
- without dressing.
The second type is also called open. It is accompanied by the appearance of the so-called “crust” on the wound - a hard scab, which protects the surface of the wound from the ingress of bacteria and dirt. On the other hand, the crust slows down the processes of epithelialization of the lesion, which is why it heals longer. Wounds that have a large area are especially inconvenient to be treated with an open pattern. That is why today the most preferred method is the treatment of wounds in a humid environment, which does not allow the scab to form, and also helps to remove exudate (effusion) from the wound cavity. In addition, treatment with bandages maintains the level of moistening of the wound, preventing its dehydration, and prevents the recurrence of infection.
The wound dressing is intended to provide a therapeutic effect on it, and to maintain the most comfortable environment for healing with protection from mechanical impact or ingress of dirt.
At the same time, the dressing on the wound should have some properties:
- ligation removes effusion from a wound, it maintains a normal level of tissue moisture and temperature;
- the material is well breathable, while retaining pathogens;
- dressing tool does not contain toxic components;
- the material covering the wound easily moves away from it, without falling to the wound.
What are the bandages for the afflicted? Wound dressing functions:
- removal of exudate;
- destruction of toxins and bacteria;
- stimulation of cleansing from the processes of necrosis;
- maintaining normal moisture in the wound;
- ensuring injury injury;
- protection against mechanical damage;
- prevent infection;
- stimulation of cell regeneration and repair processes.
Dressing materials, main types of wound dressings
The simplest and most common material for the preparation of dressings for the treatment of wounds for a long time remained sterile gauze wipes impregnated with special drugs. Today, many hospitals and medical institutions use gauze in the form of napkins to overlap the wound surface, since this material is clean, sterile, natural, and has a low cost. The disadvantage of gauze, like any textile, is a weak level of binding effusion from a wound, and an increased ability to adhere to the wound surface, although the material has good absorbing properties and is sufficiently breathable. As a result, gauze dressings on wounds quickly become saturated with secretions from them, and adhere strongly to the surface of damage, due to which the wound heals worse, and each procedure for changing dressings becomes a real test for the victim.
Modern medical science has developed the so-called interactive dressings, which affect the wound is not due to the drinks of any chemical or biological drugs, but due to the physical and mechanical properties of the dressings themselves.
By interactive include:
- sponge dressings;
- hydrogels and amorphous hydrogels;
- atraumatic ointment dressings;
- non-woven absorbent composite dressings.
Super absorbers. They are a multi-layer bandage, which looks like a pad. In the composition contains cellulose, as well as a special sorbent - powder polyacrylate superabsorbent. Before applying to the site of damage, the sorbent is activated by Ringer's solution. The substance of the solution after applying the bandage enters the wound over the next day. So, thanks to the superabsorbent it is possible to ensure continuous washing of the wound, due to which the necrosis areas are separated. Wound effusion, which secrete damaged tissue, in turn, is absorbed by the powder-sorbent. The constant flow of Ringer's solution into the wound bed contributes to its autolytic cleansing, and stimulates the granulation of the wound.
In this way, deep, superficial and tangential wounds can be treated and tamped.
Alginates. Under the alginates refers to non-woven material from the fibers of calcium alginate. Dry cloth and dressings made from it are used to wound wounds.
Sodium salts are present in the wound discharge. The dressing is based on their reaction with alginate fibers, which, when swollen, turn into a hydrophilic moist gel that fills the wound. Due to the absorption of bacteria by the gel, it is possible to reduce the concentration of pathogenic microorganisms in the wound cavity, therefore the risk of re-infection is reduced.
Bandages of this type allow you to control the abundant wound exudation, help stimulate the growth of granulation tissue. They can be used to treat acute and chronic injuries.
Wet gel consistency creates a balanced wound environment, does not allow the wound to dry, does not stick to it.
Spongy bandages. Such tools are based on foaming polymers. They have a high absorption and ventilation capacity due to their structure. In addition, they have shock-absorbing and barrier properties. A normally moist environment is created in the wound due to the effect of vertical absorption, while the wound remains isolated from secondary infection.
Modern sponge coatings are made from foamed polyurethane with an open pore structure. Their size decreases in the direction from the middle to the surface of the dressing. In the composition there is also a special hydrophilic matrix to enhance the absorption of fluid separated from the wound. Spongy coatings and materials for dressing are particularly relevant for the treatment of wounds with abundant exudation.
For the treatment of bedsores, located in different parts of the body, there are spongy bandages with anatomical features for the sacrum, elbows, heels.
Spongy dressings with hydro-active gel layer - a device designed to prevent the wound bed from drying out and adhesion.
Protected dressings of this type can remain on the wound surface until it is fully healed and epithelialized.
Hydrocolloids. A variety of membrane-type dressings, with particles of absorbent material enclosed in an elastomer with a self-locking function. Sorbent crystals, due to the properties of swelling, have good absorption properties. The membrane of hydrocolloid dressings in this case acts as a barrier to bacteria and infections. In the process of absorbing wound effusion, the crystals of the sorbent pass into the state of a gel that fills the wound cavity, thereby achieving a normal level of moisture in the wound bed.
Until the microparticles are completely liquid, the gel retains the ability to absorb wound fluid content. If the bandage has acquired the shape of a bubble, then it is time to change it. The dressing can also be used as a plaster due to the adhesive properties, and as the crystals become gelled, its ability to stick decreases, resulting in the dressing remaining glued to the skin only in uninjured places. During the dressing, the gel from the wound bed is removed with Ringer's solution.
Hydrogels. Bandages of this type consist of a semi-permeable membrane, and a gel of polyurethane polymers, which is attached to it. Gels in contact with a liquid do not change their original form, have a moderate absorption capacity. Ensuring a normal level of moisture in the wound is achieved due to the chemical composition of the gel - it contains up to 60% of water. The structure of the gel can bind and absorb wound effusion for several days after applying the dressing. By maintaining the desired level of moisture and ventilating the wound surface, regeneration and healing are stimulated.
The membrane hydrogel dressings is a barrier to microorganisms and moisture from outside. Such dressings do not stick to the wound, are easily removed during dressings, without causing the patient pain. In addition, the hydrogel-based dressings are transparent, which allows monitoring the wound healing processes without removing the dressing.
Amorphous hydrogels. The composition of the dressing includes water, glycerin, carboxymethylcellulose, hydroxymethylcellulose - substances that maintain a sufficient level of moisture in the wound. An amorphous hydrogel is characterized by a combination of the wetting and absorption properties of a liquid. In addition, Ringer's solution is present in the composition of the gel to stimulate the formation of granulation tissue.
Dressings based on amorphous hydrogel can be successfully combined with superabsorbents, spongy and alginate dressings.
The films. They are characterized by the property of maintaining the level of humidity in the wound bed. They are tightly fixed, and at the expense of transparency make it possible to observe the healing process without removing the bandage every time for inspection. Their advantages are intense barrier properties, protection from mechanical and thermal effects, from moisture and bacteria from outside.
Atraumatic ointment dressings. Ointment dressings are multi-layered nets made of synthetic or cotton fabric, in which cells of various sizes are provided containing medicinal ointment. Their use requires parallel application of dressings with sorbents. Atraumatic ointment dressings may be on the surface of the wound for more than a day, they do not stick to it, do not overdry the wound bed. Due to the sufficient width of the cells, the bandage ensures the normal outflow of wound effusion. During the dressing process, such a dressing does not injure the injured surface.
Non-woven absorbent composite dressings. The products are highly absorbable, consist of many layers, and contain non-woven sorbents, for example, cellulose. Such materials do not stick to the wound due to the presence of a hydrophobic surface, and their absorbency is almost 2 times higher than the capacity of conventional absorbent dressings on a tissue basis.
The outer membrane of the dressing has a water-repellent property and protects the wound from the ingress of microorganisms.
Today, interactive dressings are the most atraumatic for the patient and convenient for the medical staff. These funds are made from synthetic and natural materials, have the ability to maintain an appropriate level of moisture, do not stick to wounds. Interactive dressings simultaneously provide air circulation, exudate binding, sufficient moisture, as well as protection from external influences and microbial ingress. All this contributes to a more rapid healing of injuries.