PLASTIC & RECONSTRUCTIVE SURGERY

WOUNDS

DEFINITION- Disruption of the normal continuity of bodily structure due to trauma,which may be penetrating or non-penetrating.

TYPES OF WOUNDS Incised wounds Abrasions Crush injury Degloving injury Gunshot wounds Burns

PRINCIPLES OF WOUND HEALING

Lag phase (2-3 days) Incremental phase/proliferative phase (appr 3 weeks) Plateau/maturation phase (appr 6 months) Organization of scars

CLASSIFICTION OF WOUND HEALING

HEALING BY 1ST INTENTION efficient/Incised surgical wound meticulously opposed/heals with minimal scarring

HEALING BY 2ND INTENTION wound edges not opposed well/defect fills with Granulation tissue/excessive fibrosis/unsightly Scar

HEALING BY 3RD INTENTION wound healing by 2nd intention is treated by excising its margin and opposing them or covering the area with skin graft.

FACTORS INFLUENCING WOUND HEALING

BLOOD SUPPLY AGE INFECTION SITE OF WOUND NUTRITIONAL STATUS INTERCURRENT DISEASE SURGICAL TECHINIQUES CHOICE OF SUTURE & SUTURE MATERIALS

WOUND INFECTIONS

CLEAN PROCEDURES CLEAN CONTAMINATED PROCEDURES CONTAMINATED/DIRTY WOUNDS

PRINCIPLES OF MANAGEMENT OF CONTAMINATED TRAUMATIC WOUNDS

Contaminated wounds should be debrided under General anaesthesia Contaminated wound & its margins cleansed thoroughly Devitalized tissue is excised Avoid primary closure in gross contamination &when treatment delayed >6hrs Wound left open-suitable for delayed primary suture after 2-3 days or for later excision&2ndry suture Appropriate protection against tetanus Use of antibiotics

CRUSHING & DEGLOVING INJURIES,GUNSHOT WOUNDS

This type wounds should never be closed primarily - Thorough irrigation & removal of dead tissue/foreign material - Wounds lightly packed & dressed - Dressings are removed 48hrs later under Anaesthesia & further excision - Wound is closed by suture, skin grafting or flap.

BURNS
CAUSED BY

FLAMES HOT LIQUIS HOT SOLIDS STEAM IRRADIATION ELECTRICITY CHEMICALS

EFFECTS OF BURN INJURY

DESTRUCTION OF TISSUE(depth depends on heat of causative agent and contact time) loss of barrier to infection fluid loss from surface red cell destruction.

INCREASED CAPILLARY PERMEABILITY oedema loss of circulating fluid volume hypovolaemic shock

INCREASED METABOLIC RATE

CONSEQUENCES OF BURNS

Morbidity&mortality of burns depends on the site,extent and depth of burn and on age and general condition of patients Early Consequences * hypovolaemia * metabolic derangement (Hyponatremia,hyperkalemia followed by hypokalemia) *sepsis *Haemolysis with anaemia and need for transfusion *Hypothermia Short term consequences * Renal failure * Respiratory failure * Catabolism & Nutritional depletion *Venous thrombosis * Curlings Ulcer and and erosive gastritis Long term cosequences * Permanent disfigurement * Prolonged hospitalisation * Psychological problems * Impaired function

CLASSIFICATION

SUPERFICIAL PARTIAL-THICKNESS BURNS DEEP PARTIAL-THICKNESS BURNS FULL-THICKNESS BURNS

PROGNOSIS
DEPENDS ON

EXTENT OF THE BURN (Rule of Nine) DEPTH OF BURN SITE OF BURN ASSOCAITED RESPIRATORY INJURY

MANAGEMENT

FIRST AID ARREST THE BURNING PROCESS ENSURE AN ADEQUATE AIRWAY AVOID WOUND CONTAMINATION TRANFER TO HOSPITAL ADEQUATE VENTILATION INITIAL ASSESSMENT& MANAGEMENT PREVENTION&TREATMENT OF BURN SHOCK WATER REPLACEMENT BLOOD TRANSFUSION ORGAN FAILURE & BURN SHOCK NUTRITIONAL MANAGEMENT PREVENTION OF SEPTICAEMIA PREVENTION OF CURLINGS ULCER & GASTRIC EROSIONS. LOCAL MANAGEMENT OF BURNS INITIAL CLEANSING & DEBRIDEMENT PREVENTION OF CONTAMINATION RELIEF OF CONSTRICTION(ESCHAROTOMY) RESTORATION OF EPIDERMAL COVER FUNCTIONAL & COSMETIC RESULT

PLASTIC &RECONSTRUCTIVE SURGERY

Discussions

Give the definition of a wound classified as cleancontaminated and provide an example of such? What aspects of the patients health and the condition of the wound can be corrected to improve the probability of wound healing? What are the basic differences between a gunshot wound of the thigh (low velocity)which has an entrance and exit wound, and a large burn of the thigh? What aspects of a wound-traumatic or surgical cause a cosmetically poor scars?