Soft tissue wounds: Causes and treatment

Small wounds, cuts and abrasions are all common and quite common. You often encounter such troubles in everyday life. Most often, children encounter such problems, but adults are by no means immune from minor injuries.

On the one hand, the majority are sure that they probably know what to do - iodine, alcohol, a plaster or a bandage are the main helpers in trouble. However, everything is somewhat more complicated, because if the wound is treated incorrectly, you can get complications that will lead to infection, prolonged healing or an unsightly scar.

What are soft tissue wounds?

Soft tissue injuries include injuries to the skin, mucous membrane, deep-lying tissues (subcutaneous tissue, muscles, etc.), as well as tendons, blood vessels and nerves. As a result of a violation of the integrity of the skin, microbial contamination of the wound surface occurs, which can lead to the development of infection. According to the damaging factor, wounds are divided into mechanical, thermal (burn) and chemical; by instrument of injury - for wounds from blunt, sharp objects, tools and weapons, firearms and weapons; According to the nature of the damage, wounds are classified into bruised, lacerated, combined, bitten, stab, cut, stab-cut, chopped, sawn, combined bullet, shot, fragmentation. Based on the depth of damage, a distinction is made between superficial wounds, located in various layers of the skin, and deep wounds, occurring in deeper tissues. Wounds of internal organs and joints that communicate with the external environment through a wound channel are called open, and wounds whose wound channels pass through cavities or ending in them are called penetrating wounds. Wounds of internal organs that do not communicate with the external environment are classified as closed.

Classification of soft tissue injuries of the maxillofacial area.

Group I. Isolated injuries to the soft tissues of the face: - without violating the integrity of the skin or mucous membranes (bruises); - with a violation of the integrity of the skin of the face or mucous membrane (abrasions, wounds). Group II. Combined injuries to the soft tissues of the face and bones of the facial skull (with or without a violation of the integrity of the skin of the face and mucous membrane). The nature of soft tissue damage depends on the force of the impact, the type of traumatic agent and the location of the damage. Bruises Occur when a weak blow to the face with a blunt object damages the subcutaneous fat, muscles and ligaments without tearing the skin. As a result, a hematoma (bleeding) and post-traumatic edema are formed. The hematoma lasts 12-14 days, gradually changing color from purple to green and yellow. An abrasion occurs when the integrity of the surface layers of the skin is violated, which does not require sutures. It is most often observed in the chin, cheekbone, nose and forehead. Wound Formed when the skin is damaged when struck by a sharp or blunt object with sufficient force to break the integrity of the skin. The wound can be : - superficial (the skin and subcutaneous tissue are damaged); — deep (with damage to muscles, blood vessels and nerves); — penetrating into cavities (nose, mouth, paranasal sinuses); - with or without tissue defect; — with damage (or without) bone tissue; - cut, stabbed, chopped, torn, torn-bruised, bitten, depending on the type and shape of the wounding object and the nature of the tissue damage. Clinical characteristics

Features of the anatomical structure of the maxillofacial region and injuries of soft tissues of the face.

- Rich vascularity (good healing and risk of severe bleeding). — Rich innervation (possible pain shock, loss of sensitivity, paralysis of facial muscles). — Presence of salivary glands, tongue, large vessels and nerves (impaired function of swallowing, eating - chewing, difficulty speaking. When the parotid-masticatory area is injured, salivary fistulas are formed, when the facial nerve is injured - paresis of facial muscles). — The presence of a false defect (wound gaping due to contraction of facial or masticatory muscles). — Violation of the seal of the oral cavity, resulting in constant drooling (loss of fluid and nutrients) and the inability to take regular food. — Rupture of the mucous membrane due to damage by teeth. — Disfigurement with significant gaping of the wound (the type of wounded person does not correspond to the degree of damage). — There may be a true defect in the tissues of the nose, lips, ears, etc., leading to disfigurement and functional impairment. — Development of jaw contractures in the long-term period.

Local complaints

They depend on the type of damage. Bruises - complaints of pain, swelling, bluish bruising. They arise as a result of damage to subcutaneous fat and muscles without rupture of the skin, which is accompanied by crushing of small-caliber vessels and tissue imbibition with blood. Abrasions - concern about damage to the skin or mucous membranes. Pain due to a violation of the integrity of the surface layers of the skin (epidermis) or mucous membrane. Incised wound - the patient complains of injury to the skin, accompanied by bleeding and pain. There is damage to the entire thickness of the skin or oral mucosa, dissection of blood vessels, fascia, muscles, loose tissue, and nerve trunks. Puncture wound - complaints of minor soft tissue damage, moderate or heavy bleeding, pain at the site of injury. There is an entrance hole and a wound channel, and profuse bleeding when large vessels are injured. Chopped wound - the patient notes extensive damage to soft tissues, accompanied by heavy bleeding (possible damage to the bones of the facial skeleton). Lacerated wound - the presence of a wound with uneven edges (possibly with the presence of flaps and soft tissue defects), severe hemorrhages, moderate or severe bleeding, pain. Bruised wound - the presence of a wound, hematoma, hemorrhages, the presence of flaps, tissue defects, the surrounding tissues are crushed. A bite wound is the presence of a wound with uneven edges, the formation of flaps with teeth marks on damaged skin or on intact skin, there may be a tissue defect, bleeding, pain.

General complaints

Bruises, abrasions, bruised wounds, bitten wounds, lacerations - there are usually no general complaints. An incised wound, a puncture wound, a chopped wound - complaints will depend on the severity of the damage: pale skin, dizziness, weakness. Occurs due to blood loss. History of injury . Injury can be industrial, domestic, transport, sports, street, or while intoxicated. It is necessary to find out the time of injury and the time to see a doctor. If you contact a specialist late or receive incorrect care, the incidence of complications increases. Anamnesis of life . It is important to know concomitant or past diseases, bad habits, working and living conditions, which can lead to a decrease in the general and local defenses of the body and impaired tissue regeneration. General state. It can be satisfactory, moderate, or severe. Determined by the severity of the damage, which can be combined or extensive.

Causes

Incised wounds occur as a result of direct impact of a sharp weapon on the surface of the skin. Slash wounds are created when a sharp weapon is brought down onto the skin at an angle. Puncture wounds are the result of deep penetration by a sharp, thin instrument. Possible injury to cavities or joints. Contusion wounds occur when some part of the body comes into contact with a hard obstacle and there is solid support in the form of the skull or other bone. Crushed, crushed wounds are formed due to the impact of a blunt instrument with a wide surface when opposed to a solid support. Bite wounds. As a result of an animal or human bite, highly virulent wound infection pathogens can enter the wound.

Local changes in damage to the soft tissues of the face

Fresh damage

Bruises - the presence of a bluish-red bruise and swelling of tissues spreading to the surrounding soft tissues, palpation is painful.

Bruise of the soft tissues of the chin. Abrasion of the upper and lower lips

Abrasions - the presence of a wound to the surface layer of the skin or mucous membrane of the lips and oral cavity, pinpoint hemorrhages, hyperemia. Most often observed on the protruding parts of the face: nose, forehead, cheekbone and chin areas. An incised wound has cut smooth edges, usually gapes, and is several centimeters long. The length of the wound is several times greater than its depth and width, and bleeds profusely; Palpation of the edges of the wound is painful.

Wound of the lower lip with muscle damage

Incised wound of the face

A puncture wound has a small entrance hole, a deep, narrow wound channel, bleeds moderately or profusely, palpation in the wound area is painful, and nosebleeds are possible. The depth of penetration depends on the length of the weapon, the force applied and the absence of obstacles in the path of penetration of the weapon (bone). Heavy bleeding is possible when large vessels are injured, as well as destruction of the thin wall of the maxillary sinus. A chopped wound is a wide and deep wound that has smooth, raised edges if the wound is caused by a heavy sharp object. At the edges of the wide wound there is bruising, bruising, and additional tears (cracks) at the end of the wound when injured by a blunt object. In the depths of the wound there may be bone fragments and fragments in case of damage to the facial skeleton. There may be severe bleeding from a wound (nose, mouth) with penetrating wounds into the oral cavity, nose, or maxillary sinus. The lacerated wound has uneven edges, moderate or extensive gaping, there may be flaps when one skin or an entire layer is torn off; hemorrhage into the surrounding tissues and their detachment, palpation of the wound area is painful. This wound is caused by a blunt object and occurs when the physiological ability of the tissue to stretch is exceeded, and can simulate the formation of a defect. The bruised wound has an irregular shape with frayed edges. Additional breaks (cracks) may extend from the central wound in the form of rays; pronounced hemorrhages along the periphery and edema. The bite wound has uneven edges and resembles a laceration in nature, often with the formation of flaps or a true tissue defect with the presence of teeth marks. The bleeding is moderate, palpation in the wound area is painful. Most often observed in the area of the nose, lips, ear, cheeks. Traumatic amputation of tissue, part or all of the organ may occur

Additional research methods

Examination of the wound canal using a probe inserted into it. It is carried out to determine the length of the wound channel and its location in relation to vital organs. Radiography . - Puncture wound - there may be damage to the bone in the form of a hole as a result of a perforated bone fracture or the presence of a foreign body (part of a broken off wounding object). - Vulnerography of a stab wound - if it is impossible to examine the wound with a probe, a radiopaque substance is injected into the wound canal and X-rays are taken. - Chopped wound - the presence of bone damage and bone fragments when the bones of the facial skeleton are damaged. — A bruised wound is the presence of a fracture gap in the area of damage to one or another part of the facial skeleton (upper or lower jaw, zygomatic arch, nasal bones). General clinical blood tests. It is carried out in case of extensive blood loss in the case of cut, stab and chopped wounds to determine the blood group and Rh factor for the purpose of blood transfusion.

Symptoms

You can suspect a closed injury if you know the mechanism of injury (for example, a blow with a blunt object) and if one or more signs are present: bruising, swelling, pain. Some signs suggest the nature of the injury. For example, swelling and deformity may indicate a closed fracture. A bruise on the head, bloody discharge from the nose, ears and mouth - possible injury to the cervical spine or brain. Bruises on the chest, deformation, violation of symmetry - possible chest injury with damage to the ribs and sternum. Troubled breathing may indicate a lung injury. Large bruises on the abdomen – possible injury to an internal organ. Signs of a wound vary depending on the type and depth of tissue damage. As a rule, any damage is accompanied by pain, possible violation of the integrity of the skin, as well as bleeding.

Differential diagnosis of injuries to soft tissues of the face

Bruises : differentiated from hematoma in blood diseases. — Similar symptoms: the presence of a bluish-red bruise. — Distinctive symptoms: no history of trauma, pain. Abrasions : differentiated from scratches. — Similar symptoms: violation of the integrity of the surface layers of the skin, mild pain. — Distinctive symptoms: thin linear damage to the superficial layers of the skin. Incised wound : differentiated from a chopped wound. — Similar symptoms: damage to the skin or mucous membrane and underlying tissues, bleeding, pain. — Distinctive symptoms: extensive damage to soft tissues, hemorrhage into surrounding tissues, deep wound, often accompanied by damage to the facial skeleton. Laceration : differentiated from a bite wound. — Similar symptoms: the presence of an irregularly shaped wound, loose, uneven, scalloped edges, flaps or soft tissue defects may form, bleeding, pain. — Distinctive symptoms: animal and human teeth are wounding weapons; their imprints can remain on the skin in the form of bruises. Incised wound : differentiated from a stab wound. — Similar symptoms: damage to the integrity of the skin or mucous membrane, bleeding, pain. — Distinctive symptoms: the presence of a small, sometimes pinpoint entry hole and a long, deep wound channel.

Diagnostics

For small superficial wounds that are not accompanied by general symptoms, the diagnosis is made based on the clinical picture. A detailed examination is carried out during the initial treatment of the wound. For extensive and deep wounds with a violation of the general condition, additional studies are necessary, the list of which is determined taking into account the location of the damage. For injuries in the chest area, a chest x-ray is prescribed, for injuries in the abdominal area, an abdominal x-ray, ultrasound or laparoscopy, etc. If a violation of the integrity of blood vessels and nerves is suspected, consultation with a neurosurgeon and vascular surgeon is required.

Fast wound healing

CONDITIONS

The wound must be clean, free of foreign matter, dirt, particles, and non-viable tissue;
The wound should not be infected;
The wound should not remain open and in contact with the environment;
Healing should occur in moderately
moist environment.

And now, in order: Condition of the wound.
It should not contain foreign particles, dirt, or non-viable tissue.
Any dirt, clotted blood and pus must be removed, that is, the wound must be treated and washed. Hydrogen peroxide, saline solution, or, in extreme cases, just clean water will do. If the wound is chronic, poorly healing with a dry, poorly detachable bottom (eschar), it is necessary to use a special gel ( Fibrogel Ag
or
Intrasite gel
) in combination with a secondary absorbent dressing (Allevyn Adhesive, Non Adhesive), or in combination with a breathable film dressing (Opsite FlexiFix , Opsite Flexigrid). However, if you have a deep chronic wound, we recommend that you first seek help from specialists.

Presence of infection.

The presence of an infectious process in the wound negatively affects the healing process.
If measures are not taken, the wound may become chronic, as a result of which the healing process may take a long period. It has long been proven that silver has a pronounced antibacterial effect, due to which the use of silver-containing dressings significantly helps to block the growth of bacteria and the development of infection in the wound. If there is an infectious process, it is necessary to use a bandage with silver nanocrystals (Acticoat or Acticoat 7); Neofix Fibrotul Ag
. Matching headbands are here.

Closing the wound.

The wound must be protected from environmental influences and infection. If the wound is small, an abrasion or a scratch, it is enough to treat it with a special film spray (Opsite Spray) or cover it with a breathable film bandage (Opsite FlexiFix, Opsite Flexigrid). The dressing for wounds of medium size and depth should be sterile, impervious to moisture and microorganisms from the outside, and also facilitate the absorption of exudate and removal of excess moisture (Neofix Post, Opsite Post Op, Opsite Post Op Visible).

Humid environment.

It was previously believed that for a wound to heal quickly, it should be as dry as possible, but modern experience shows that for successful and rapid wound healing, a moderately moist environment must be maintained in it. In a humid environment, enzymes and growth factors are most active and cell growth and reproduction are more active, but excess moisture must be removed. Optimal moisture in the wound is maintained with breathable patches (Neofix Post, Opsite Post Op, Opsite Post Op Visible) when there is little exudate, or sponge dressings when there is a lot of discharge (Allevyn Adhesive, Non Adhesive).

WHAT TO DO?

If the wound is small, then you need to do the following:

Clean the wound - rinse with hydrogen peroxide, it will help remove small foreign objects, particles of dirt, non-viable tissue, and blood clots from the wound. If there is no hydrogen peroxide, then you can simply wash the wound with water or saline;
Treat the edges of the wound. In this case, iodine or a solution of brilliant green (brilliant green) is suitable. To prevent wound infection, you can use a silver-containing dressing, Neofix Fibrotul Ag, fixing it on the wound with a patch or film type bandage (Opsite FlexiFix, Opsite Flexigrid);
You can also simply cover the wound after treatment with a non-stick, breathable, moist dressing. Or a patch with the same properties. In this case, any adhesive bandage on a non-woven or film base (Neofix Post, Opsite Post Op) is suitable.

CONCLUSION OF WOUND EDGES

For additional fastening of the edges of a sutured wound, as well as for bringing together the edges of an incised wound after treatment, you can use LEUKOSTRIP adhesive strips. They reliably fix the edges of the wound, allow air to pass through, and remove excess moisture.

SUPERFICIAL WOUNDS, EXTENSIVE Abrasions

To ensure healing of a superficial wound, non-adhesive mesh dressings containing paraffin (Jelonet) are used as the primary wound covering. If there is a risk of wound infection, as well as to prevent infectious complications, a mesh dressing containing soft paraffin and an antiseptic (Bactigras) can be used as a primary wound covering. To remove excess fluid (exudate), an absorbent secondary layer is applied over the mesh bandage - a sponge bandage (Allevyn Adhesive, Allevyn Non Adhesive). Fixation can be achieved using a breathable film bandage (Opsite Flexifix, Opsite Flexigrid).

WOUNDS ON THE FACE

Wounds on the face require a special approach, since wound healing should lead to minimal cosmetic defects. For additional reduction of the edges of the wound, if the wound is sutured, or as a primary dressing, you can use special adhesive strips - strips (Leukostrip). The range of leading manufacturers of plasters includes a large number of simulated bandages (cut to size), with which you can carefully close the wound. If a scar has formed after healing, you can use a special silicone bandage that is designed to reduce and eliminate scars (Cica-Care). You can buy Cica-Care silicone patch here.

POST-OPERATIVE WOUNDS

We recommend covering postoperative wounds with specialized dressings. The structure of the dressing provides a favorable environment for healing and its painless change when dressing. Thanks to the inner layer, the bandage is securely fixed to the skin, but later it can be easily and painlessly removed. The middle, absorbent layer, consisting of viscose or polyurethane foam, ensures quick and reliable removal of exudate. The outer film or non-woven layer ensures rapid and constant evaporation of excess moisture. Among non-woven based dressings, we recommend using Neofix Post and Primapore. Among film-based dressings, Opsite Post Op and Opsite Post Op Visible have proven themselves to be excellent.

PURPUS WOUNDS

The presence of pus in the wound indicates that an infectious process has begun. Treatment of purulent wounds, especially large and deep ones, requires qualified medical care and an integrated approach. For such a case, we can recommend the following dressings: - For cleaning a wound with a dry, poorly detachable bottom (scab), or in the presence of a dense fibrin film at the bottom of the wound, hydrogel (Intrasite Gel) has proven itself very well. It must be applied to the surface of the wound, and then covered with a secondary film or sponge bandage. After 48 hours, the wound needs to be washed and cleaned. — For the treatment of purulent wounds, dressings with silver nanocrystals (Acticoat and Acticoat 7) have proven themselves to be excellent. Silver, acting as an antiseptic, is released gradually, providing a long-lasting and permanent effect. Acticoat dressing can be left on the wound for up to 3 days, Acticoat 7 for up to seven days. These dressings are primary; after application to the wound, they must be covered with a secondary absorbent dressing. Before use, silver-containing dressings must be moistened with distilled water or water for injection. Go to CATALOG OF BANDAGES

Treatment

First medical aid consists of primary surgical treatment of the wound, during which foreign bodies are removed from the wound, bleeding is stopped, the wound is washed with antiseptics, and non-viable tissue is excised. The issue of preventing tetanus and rabies (if the wound is a bite) is also being addressed. Wounds with severe inflammation are not sutured; they are drained. An infected wound heals by secondary intention. Dressings and drainage changes are performed daily. General treatment consists of anti-inflammatory therapy, administration of hemostatic agents, and painkillers. In case of heavy blood loss, the issue of replacing the volume of circulating blood (CBV) is resolved, blood substitutes and blood components are introduced. Subsequently, in case of severe scar contractures and deformities, restorative surgery may be repeated. Most often, superficial wounds do not bleed much. Therefore, help consists of bandaging the wound. Before this procedure, the edges are lubricated with an antiseptic, making sure that it does not get into the wound. The wound is covered with a sterile napkin and bandaged. If the edges of the wound are significantly separated, before applying bandages they must be brought together (but not until they are closed) and fixed in this position with 2-3 strips of adhesive tape. The wound should not be washed with water (risk of infection), or with alcohol or iodine tincture. A disinfectant solution entering a wound causes the death of damaged cells and also causes significant pain. Do not apply any ointment to the wound, or place cotton wool directly into the wound. We should not forget about vitamin therapy. Vitamin deficiency sharply slows down reparative (restorative) processes. To speed up wound healing, proper nutrition of patients is important, especially those who have suffered traumatic shock, severe infection or major surgery. They need a complete diet with increased amounts of protein and vitamins. Physical therapy is indicated primarily for purulent wounds of the upper extremities. Physiotherapeutic procedures play an important role: ultraviolet irradiation, UHF, etc.

Treatment of facial soft tissue injuries

Emergency care : carried out at the prehospital stage to prevent wound infection and bleeding from small vessels. The skin around the wound is treated with iodine solution, the bleeding is stopped by applying a bandage. For abrasions, the primary dressing can be performed using a protective film of film-forming preparations applied to the wound. If there is simultaneous bone damage, transport immobilization is applied. Treatment of a patient in a clinic Indications : bruises, abrasions, cut, stab, torn, bruised and bitten wounds of small size, requiring a small excision of its edges and subsequent immediate suturing. Treatment of a bruise : cold in the first two days, then heat to resolve the hematoma. Treatment of abrasions : treatment with an antiseptic, heals under the crust. Treatment of cut, stab, lacerated, bruised, bitten wounds. PSO of the wound is performed. PHO is a set of measures aimed at speedy and without complications wound healing. PCS must be radical, immediate and final.