Wounds, surgical; traumatic
General Surgery Wounds, surgical; traumatic Dr. Ziad H. Delemi B.D.S, F.I.B.M.S (M.F.) Mosul university- College of dentistry-oral & maxillofacialsurgery department Surgical incisions Incision: A cut produced surgically by a sharp instrument that creates an opening into an organ or space in the body. Rules of surgical incisions: Accessibility Extensibility Security Esthetic ( previous scar ) Rapidity Parallel to skin creases Built of the patient Mosul university- College of dentistry-oral & maxillofacialsurgery department Surgical incisions Principles in doing surgical incisions:
A sharp knife should always be used. One stroke throughout the required distance. The blade held perpendicular to the skin surface. A fresh new knife used to incise deeper layers to avoid contamination. Adequate length should always be used. Mosul university- College of dentistry-oral & maxillofacialsurgery department Surgical incisions types: Abdominal incisions:-vertical: midline
--paramedian --pararecus -transverse -obliquegridiron --subcostal Mosul university- College of dentistry-oral & maxillofacialsurgery department Surgical incisions 2- Abdominothorasic
3- head & neck & face: -bicoronal -submandibular -Weber Fergusson -trachiostomy -radical neck MacAfee - thyriodectomy 4- breast : mastectomy, circumareolar 5- chest wall & back incisions Mosul university- College of dentistry-oral & maxillofacialsurgery department Mosul university- College of dentistry-oral & maxillofacialsurgery department Surgical &Traumatic Wounds
Wound : is a break or loss of continuity of skin or mucus membrane . Causes: Iatrogenic surgical incisions Traumatic RTA, assault, war injury Types: 1- incised wound: due to sharp instrument , relatively clean 2- lacerated wound: due to RTA, machinery accidents. 3- crushed wound: due to war injury. 4- puncture wound: penetrating or perforated 5- avulsed wound: shell injury Mosul university- College of dentistry-oral & maxillofacialsurgery department Surgical &Traumatic Wounds
Mosul university- College of dentistry-oral & maxillofacialsurgery department Surgical &Traumatic Wounds
Mosul university- College of dentistry-oral & maxillofacialsurgery department Surgical &Traumatic Wounds
Classification of Surgical Wounds According to Degree of Contamination: Class I: Clean wound, like surgical incisions that are made electively during surgical procedures in an aseptic environment. Class II: Clean contaminated wound, the kind of aseptic elective surgical incision that is made in a contaminated environment, like oral cavity, as it normally contains huge number oral flora carried in saliva. Class III:Contaminated wounds and those usually are not elective but traumatic in origin like fresh skin lacerations, opened fractures and penetrating wounds. Class IV: It is a dirty contaminated wound, usually contains devitalized tissue or preexisting infection prior to operation Mosul university- College of dentistry-oral & maxillofacialsurgery department Surgical healing Pathology of wound healing:
1- small blood or fibrin clot 2- epithelization 3- wound contraction 4- fibrosis & scar formation Mosul university- College of dentistry-oral & maxillofacialsurgery department Surgical healing Types of wound healing:
1-primary intension: seen when the wound is brought in anatomical layers & approximated by sutures, staples, clips, adhesive glue, steristrips. 2-secondary intension: seen when the wound layers cannot be approximated due to big wound or skin loss or ulcer so it will be heal by contraction epithelization granulation tissue slow healing ugly scar. Mosul university- College of dentistry-oral & maxillofacialsurgery department Surgical healing Factors affecting the wound healing General factors:
1-hypovitaminosis A& D. 2-malnutrition, uremia, jaundice, DM. 3- hematological diseases leukemia, lymphoma. 4- malignant diseases catchexia, chemotherapy. 5- chronic generalized diseases TB, ulcerative colitis. Mosul university- College of dentistry-oral & maxillofacialsurgery department Surgical healing Factors affecting the wound healing Local factors:
1- poor blood supply. 2- hematoma. 3- infection. 4- tension in the wound. 5- bad surgical technique. 6- foreign body. Mosul university- College of dentistry-oral & maxillofacialsurgery department Treatment of wounds 1- primary suturing: done for clean wound
2- delayed primary suturing: done if the wound is lacerated or heavy infected. 3- secondary suturing: if we had done primary suturing & infection developed pus under skin so need open & frequent dressing then resuturing. 4- skin graft : big wound & impossible to reapproximate the wound edges, so it is important to cover the denuded area to prevent bacterial infection & fluid loss. Mosul university- College of dentistry-oral & maxillofacialsurgery department scar Scar : is a remnant of wound healing Stages of scar
Stage 1- (1-4wks)scar is fine, soft, weak. Stage 2- (4-12wks) red, thick, strong, contracted, raised above the level of skin, itching. Stage 3- (12-40wks) white soft, tend to relax. After 1-2 years very fine not obvious scar Mosul university- College of dentistry-oral & maxillofacialsurgery department scar Factors affecting scar:
1- age best in extreme age worse in children. 2- race: better in white worse in dark skinned 3- position in the body: face good, sternum bad 4- direction of the wound: if parallel to skin creases minimal scar. Mosul university- College of dentistry-oral & maxillofacialsurgery department scar Complications of scar: 1- excessive contracture deformity.
2- may adhere to nerve neuroma. 3- keliod. 4- hypertrophic scar. 5- unstable scar 6- malignant changes epitheloma scar Mosul university- College of dentistry-oral & maxillofacialsurgery department scar Hypertrophic scar: there is excessive fibrous tissue formation in young people specially after burn, if stage 2 persists more than 6 months, Hypertrophic scar will happened. Avoided by pressure bandage which flattens the scar. Mosul university- College of dentistry-oral & maxillofacialsurgery department scar Keloid scar: it is a persistent of Hypertrophic scar more than one year extending to the neighboring skin , the best treatment are radiation, steroid injection, shaving with skin graft. Mosul university- College of dentistry-oral & maxillofacialsurgery department Quiz What are the differences between Thrombophlebitis and Phlebothrombosis ? Mosul university- College of dentistry-oral & maxillofacialsurgery department