外科伤口的处理

外科伤口的处理 Treatment sharing of common wounds Author: Lily has been shared 90 reviews (0) copy link 1. clean the wound with Iodophor disinfection, stimulate small, good effect; for cleaning, new granulation wound, but also can be covered with vaseline gauze, in order to reduce the patient's pain when dressing change, and reduce tissue fluid exudation and loss. 2., rich blood supply, small chance of infection, physiological saline can be used for simple wetting, sterile excipients can be wrapped. 3. for skin defect wound defect with saline repeated washing, available around the iodophor disinfection, after disinfection with saline gauze or vaseline gauze, saline gauze helps keep the wound dry, fresh, vaseline gauze can promote wound granulation. The 4. principle is infected or contaminated wound drainage drainage when necessary, split open suture, expand the wound, thorough drainage, wound with hydrogen peroxide and repeated washing with normal saline, necrotic tissue should be given debridement, can also use antibiotic gauze packing in the wound, wound around the best two times three times with iodine alcohol dehydration iodine disinfection. Of course, infection, wound dressing should be changed every day. In addition, the festering wound dressing, do not despise the stench, must carefully erase the pus incision, and not because of pain and touch the incision, pus after removal to a slight oozing blood, so as to contribute to the early healing of incision! 5., bedsore, Purulent Osteomyelitis and other infectious wound: iodophor disinfection around the wound, and the wound to hydrogen peroxide, saline irrigation, gentamicin dressing coverage. 6. for osteomyelitis, there is bone exposure when changing dressings first, because there is a lot of exudation, and more dressings. The necrotic tissue should be removed at any time during the change of dressing, and the gauze can be placed in the medullary cavity. The experience method is to rinse the wound with salt water first, then rinse with 0.1% iodophor, then rinse with hydrogen peroxide. Finally, it is covered with a large gauze and covered with dressing. When the granulation of the wound is fresh and the exudation is less, the dead bone and sclerotic bone are removed by operation, and the wound is covered with an appropriate myocutaneous flap. The external fixation of the external fixator is performed until the flap is survived, and then the bone is lengthened. 7. open fracture external fixation of the patients. Follow the first iodophor disinfection (while cleaning up the removal of the necrotic tissue), followed by the use of hydrogen peroxide disinfection, and physiological saline, finally nitrofurazone packing cover wound. Wait for its granulation growth, free flap coverage. 8. incision fat liquefaction: fat rich places prone to fat liquefaction, at this time a wide open incision (fat liquefaction area all open), culture + drug sensitivity, strengthen dressing change. This incision to change a long time, in order to shorten the time, in the early stage after disinfection in the subcutaneous injection of gentamicin locally, placed in a day to glucose, wound dressing, wound exudation, less oil gauze to stimulate the growth of granulation, fresh after two suture or butterfly tape pulling. 9., the wound will not heal, traditional Chinese medicine should be changed. Traditional Chinese medicine dressing has its unique features, but there is usually no concept of asepsis. For example: for the refractory sinus (such as brain surgery, heart bypass surgery or chronic osteomyelitis caused by sinus, usually early in 82 or 91 Dan Dan + Red ointment, provided to rot pus, later with Shengjisan + Chili oil cream healing, the effect is very good, Even Pseudomonas aeruginosa or drug-resistant staphylococcus aureus infections can be cured. 10. of the pollution of oily wounds, we use turpentine oil to grease it. 11. for the old wounds: the poor regeneration ability of granulation tissue (color dark red, not fresh, rugged, sometimes with old hemorrhage appearance), surrounding tissue healing is not easy, to curette scraping and cut off the surface of granulation tissue, the hemorrhage, with fresh granulation, external plaster (this is the traditional Chinese medicine Qufushengji said, western medicine is to reach the purpose of hydrogen peroxide to rot). If there is pus, should observe whether the abscess or sinus, pay attention to temperature changes of the patients. 12. for Pseudomonas aeruginosa infection wound: the characteristics of pus is light green, there is a special kind of sweet fishy smell, if the scab, scab empyema, necrotic tissue, to remove the crusts, pus and necrotic tissue. Early green pus infection in burn wounds can cut scab and skin grafting. You can also use 1%~2% phenoxyethanol wet or 0.1% gentamicin, 1% silver sulfadiazine, 10% mafenide wetpacking etc.. If the wound is smaller, 3% acetic acid, 10% chloral hydrate and other wet solution can be applied. Dressing: trauma, open extension and soft tissue infection, incision and drainage of incision infection, due to pathological reactions of local tissue, the wound fluid seeping, suppuration, necrosis or tissue defects, should be properly handled. This process includes checking the wound, remove pus and necrotic tissue, placed or removal of drainage and dressing change of dressing, a process called dressing, also known as the replacement or dressing. Objective: 1. to observe the wound; 2. remove necrotic tissue; 3. clean the wound; 4. unobstructed drainage; 5. promote the growth of tissue; Principle: 1. asepsis principle; 2. remove necrotic tissue; 3. maintain and promote granulation growth; 4. promote wound healing; The basic techniques of dressing change: 1. to establish aseptic concept; 2. to remove dressing methods; 3. methods of transfer of wound materials; 4. disinfection methods for wound surface and surrounding skin; 5. bandaging fixation method; 6. treatment of dirt dressings; To fully understand the 1. wound dressing, wound site size depth, number of wound cavity filling gauze, drainage and whether the removal or replacement, whether need debridement or flushing, whether you need stitches or suture. The required equipment to check whether drugs dressings are available, special activities should be prepared to complete, such as antibiotic solution configuration the wound coated with a local anesthetic, blade debridement required, long forceps for deep wound probe, special drainage tube replacement suprapubic cystostomy. Full understanding should be given to the patient's mental state, general condition, and possible changes in the course of the change. 2.: General requirements for the preparation of sterile dressing in the morning nursing hours or dressing room cleaning work late, the best in the dressing room dressing. Wear mask hat, the patients at the dressing room, observation of the wound (along the direction to uncover gauze wound off, easy to wound dehiscence and vertical open), assessment of the need for equipment, quantity, and dressing type, and then wash your hands after preparing dressing items. Generally requires two aseptic bending disc, two tweezers, alcohol, cotton balls, etc., when holding equipment, tweezers must head down, can not get up, clamping order, first tweezers, placed in the middle of the bent plate, Yarn cloth over the top, iodine, alcohol placed on both sides of the curved plate, the first clip after clip cotton iodine alcohol cotton (if the first clip residual alcohol, alcohol cotton ball clamp forceps is diluted iodine iodine, affecting the disinfection effect). 3., operation: hand take external accessories, and then use tweezers to take the inner layer, if you stick with saline cotton ball, wet opened. Two tweezers, a touch of skin, a touch of accessories (both do not touch). Disinfect gently along the wound and suture, then clean (clean wound) from the inward, outer, back, type, eliminate alcohol two times or more, the scope should be more than the gauze covered. Light cover yarn face down, cover eight layers of gauze above (usually a piece of gauze block four layer). Adhesive tape should be in the direction of the skin and vertical, gauze stick, general three, both sides of the edge of pressure sticky, in the middle of a bar. Finally, wash your hands (protect yourself). The 4. order: first clean, after pollution, simple, complex. So does a patient with multiple wounds. On the principle of wet dressing frequency should be accessories general wound dressing 1.: for the first time in 24h, after every 2-3 days / times; 2. special wound: breast surgery, 3-5 / day; 3. days after skin grafting: 7-9 / 4.; digestive tract fistula: 2-3 days / times; the summer of 5., every day, enough alcohol yarn; Dressing selection in the first few days, the growth of the wound is mainly granulation tissue growth, it requires a relatively moist environment, so the beginning of a few days, dressings can use several layers to keep the wound relatively moist. But in the later stage, the wound growth mainly is the cutin growth, at this time the wound surface needs the relatively dry environment, therefore the dressing should act as the isolation function under the premise as thin as possible. In addition to the protection from external wound dressing pollution effect, but also has a certain role of drainage, so the dressing should guarantee the dressing and wound tightly, especially when compared to the wound around the indentation. Commonly used dressings 1. alcohol: bedsore protection (50%), skin and instrument sterilization (70%). The wound with complete epidermis can be changed with alcohol. If the epidermis is damaged, alcohol can not be used, and iodophor is usually used. The classic 2% iodine disinfection method is two times three times and iodine alcohol. 2. iodophor: less irritating to mucosa, no need for ethanol to remove iodine, no corrosive effect, and low toxicity. Whether it is the scope of application of iodophor (mucosa, skin, etc.) or the disinfection effect was better than that of iodine (less allergic reaction), but there is also scope, bleeding wounds, the effect is not good, also should not be applied to large areas. Some hospitals have been eliminated because of iodine, allergic reactions, need deiodinase, have a corrosive effect. A more suitable range for the use of iodophor and alcohol. Iodophor is complexed iodine, which is ineffective or ineffective for greasy wounds or sebaceous glands. While alcohol or iodine can skim, better fixed bacterial protein, while the rich sebaceous gland place more penetrating. So it can be applied around the scalp. 3. physiological saline (0.9%): the washing of the wound wet compress. Generally used in the blood supply is rich, more wound secretion, small infection, and a keen sense of mucous membrane. The application of physiological saline is mainly for injection and wetting, because for a wide area of wound or combination of uneven wound, the injection can find some impurities and infection. Four Hypertonic saline: used when the wound edema is heavy. Hypertonic saline to local swelling wound healed, and can achieve partial dehydration. Hypertonic saline plus Vaseline gauze can stimulate granulation growth. It is often used in clinic without a closed wound or infected wound after debridement. 5. glucose as a dehydrating agent, can increase the plasma osmotic pressure due to dehydration, the infected wound in local area, poor nutrition, wound dressing with other drugs after poor or no effect, varicose veins of lower extremity skin erosion and ulcer, wound healing is difficult, superficial and deep second degree small burn edema, slow wound healing, obvious curative effect and bedsore. Hypertonic glucose can be evenly distributed on the wounds caused by hypertonic environment caused by bacteria, bacterial cell dehydration, loss of reproductive capacity, cell death, and can make the body of local cell dehydration, reduce the wound and granulation tissue edema, and can form a protective film to prevent infected cells continue to invade, can improve local blood circulation, improve wound around the nutrition. To promote wound healing; in addition, glucose has the myogenic effect, can reduce wound pain, promote wound healing. 6. hydrogen peroxide (3%): cleaning wounds, ulcers, pus sinus, loose necrotic tissue, remove adhesive dressings. 7. gentamycin sulfate (0.2-0.5%): local irrigation is used for Pseudomonas aeruginosa and Staphylococcus aureus wound. 8. Furacilin Solution: (0.02%) disinfection, purulent wound surface ulcer. 9. Zinc Oxide gelatin: a long lasting ulcer of the leg. 10. insulin is mainly used in non healing wounds of diabetic patients. 11. (2%): mercurochrome disinfection of skin and mucosa, skin abrasions mercurochrome best, with more than ten minutes after drying no bandage 12. Cod Liver Oil: local application, to promote wound epithelization. 13. acetic acid (0.5-2%): burns, burns, infection wounds. 14., wash must be too (0.05%): wound, wound irrigation. 15.: the best effect of wound contraction of rivanol (direct wet coating). 16. Magnesium Sulfate (50%) solution: for contusion, cellulitis, erysipelas, antiphlogistic detumescence. Local wet compress. 17. Boric Acid Ointment (5%): burns, abrasions, skin ulcers, and decubitus ulcers. Wet with boric acid solution until the granulation is fresh. Use of muscle powder at the end of the granulation can promote granulation growth. 18. wound surface wet is beneficial to tissue growth, the main reason for this is that we usually love using saline gauze to cover the wound, and physiological Shiomizu Sabu and unobstructed drainage role, but due to the humid environment is a hotbed of bacteria, the bacteria enter the logarithmic growth phase in the 6-8 hour, the severe wound infection, should be done wash dressing (preferably 3-4 times / day), many people love the wound combined with gentamicin wet head 1-2 effect is very good, long-term effect is poor, and easily lead to the emergence of drug-resistant strains. 19. Vaseline gauze can provide a moist environment conducive to the growth of wound granulation, and can reduce the tissue fluid exudation, early wound can also stop bleeding, but for severe wound infection should be used with caution, because of its easy because of poor drainage, often aggravate infection. Note 1. aseptic phase of wound dressing, usually in 24 hours, 72 hours routine observation of local swelling, exudation. 2., open injury, after 24, 48, 72 hours for three days change, pay special attention to prone to hematoma or drainage, timely elimination of dangerous situation is more critical. The 3. Department of orthopedics wound wound infection is more common skin necrosis, bedsore, hypertonic saline in a certain period of time, by weight, exudation in wound infection, can reduce the wound and granulation tissue edema quickly and reduce leakage. 4. replantation surgery or vascular anastomosis flap surgery is best with Furacilin Solution and the temperature close to the dressing, dressing gauze bandage should avoid finger ring, the best use of local broken gauze packing. 5., for large areas of wound, first pay attention to debridement, for the necrosis of the tissue, including necrotic tendons and vascular tissue, do not tolerate, and strive for several changes in the dressing, once the boundaries are clear, then decisively removed. Barely staying will only retard granulation growth and even cause infection. 6. to remove most necrotic wounds, to take care of the growth of granulation, granulation tissue itself has the ability to resist infection, if there is no obvious exudation, do not use antibiotics or other medicine dressing with Iodophor disinfection wound edge skin, covered with wet saline gauze. 7., do not put the oil on the wound surface, it should be in the brine gauze, to prevent excessive evaporation of salt water. 8., there are infected wounds, pay attention to do a bacterial culture + drug sensitivity re dressing, so as not to be passive later. The dressing theory no longer goes into details. Finally, we talk about the observation of one of the wounds. What have we observed? The state and the description of the problem, also is to the organization cognitive problems, such as health and granulation edema granulation of different specific tissue necrosis infection even the smell of them, how to ways in which you want them toward the direction of development, this is the surgeon is more like a farmer, diligent and devout Watch their own crops, and the harvest with hope, and we want to rescue operation and global visions, and we need more nuanced dressing is more and more, this is a kind of attitude, I see: summary of dressing dressing is observed, an important surgical treatment means intervention and help organizations healing, is one of the important criteria of the quality of the surgeon