Treatment of purulent wounds

A purulent wound is characterized by the presence of pus, tissue necrosis, the development of microbes, edema of tissues, the absorption of toxins. The principles of treatment of purulent wounds are based on the teaching about the processes occurring in the wound during its healing, and the conditions that promote regeneration. Tasks of treatment: removal of pus and necrotic tissues; reduction of edema and exudation; control of microorganisms.

To treat purulent wounds, it is necessary to provide factors for local and general effects on the body. These factors differ in different phases of wound healing and this was mentioned in the section than to treat purulent wounds .

Stages of wound process: inflammation, regeneration, epithelization.

All medical measures are carried out in strict accordance with the stages of the wound process. For each stage there are their treatment tasks, as well as ways to achieve them.

Inflammation

The stage is characterized by the presence of all signs of a purulent wound process. In the purulent wound there are remains of non-viable and necrotic tissues, foreign objects, pollution, accumulation of pus in the cavities and folds. Viable tissues are edematous. There is an active absorption of all this and microbial toxins from the wound, which causes the phenomena of general intoxication: fever, weakness, headache, lack of appetite, etc.

In this regard, it is necessary to ensure:

1) rest of the diseased organ (immobilization, rare dressings);

2) administration of antibiotics and antiseptic agents both topically to the wound, and inside or intramuscularly;

3) increased hyperemia and exudation to the wound using bandages with hypertonic solutions of table salt (5-10%), this improves the processes of melting in the wound and creates unfavorable conditions for the life of purulent microorganisms;

4) Activation of immunobiological reactions primarily by enhancing the phagocytic activity of leukocytes, using transfusions of small doses of blood, etc .;

5) reduction of purulent intoxication by creating a reliable outflow of wound exudate through a wide opening of the purulent focus and draining it;

6) careful attitude to the tissues of the wound, preventing injuries to the walls of the wound to preserve the emerging barrier.

The objectives of the treatment phase: draining the wound to remove pus, necrotic tissues and toxins; infection control. This sequence is valid even when the wound is festering . Drainage of the wound can be active (with the use of aspirations) and passive (drainage tubes, rubber strips, gauze napkins and turundas moistened with water-salt solutions of antiseptics.) Medicinal (medicinal) remedies for treatment.

The most commonly used by surgeons is a 10% solution of sodium chloride (the so-called hypertonic solution).

In surgery, various ointments are used on fat and vaseline-linolenic basis; Vishnevsky ointment, sintomycin emulsion, ointments with a / b - tetracycline, neomycin, etc. But such ointments are hydrophobic, that is, they do not absorb moisture. Because of this, tampons with these ointments do not provide an outflow of wound secretion, they become only a stopper. Pathogenetically justified use of new hydrophilic water-soluble ointments - Levosin, levomycol, mafenide-acetate. The osmotic activity of these ointments exceeds the action of the hypertonic solution 10-15 times, and lasts for 20-24 hours, so one dressing per day is sufficient for effective action on the wound.

The arsenal of antiseptic and disinfection means is huge and necessary for the treatment of purulent wounds. Unfortunately, the antiseptic means with which our medical and sanitary facilities are equipped do not meet modern requirements. In the "National List of Essential Medicines and Medical Products", boric acid, iodine, hydrogen peroxide, potassium permanganate, ethanol, brilliant green, bigluconate chlorhexidine are included in the group of antiseptics, ie, most of the drugs used in Lister's time. Until now, many medical institutions use furacillin, which is not only inactive for many microorganisms, but is also an excellent medium for the reproduction of some pathogenic and opportunistic bacteria.

Necrolytic drugs are used to remove the dead tissues as soon as possible. Extensively used proteolytic enzymes - trypsin, chymopsin, chymotrypsin, terrylitin. These drugs cause lysis of necrotic tissues and accelerate the healing of wounds. However, these enzymes also have disadvantages: in the wound enzymes retain their activity no more than 4-6 hours. Therefore, for effective treatment of purulent wounds, bandages should be changed 4-5 times a day, which is almost impossible. It is possible to eliminate such a deficiency of enzymes by including them in an ointment. So, ointment "Iruksol" (Yugoslavia) contains the enzyme pentidase and antiseptic chloramphenicol. The duration of action of enzymes can be increased by immobilizing them in dressings. Thus, trypsin immobilized on napkins is effective for 24-48 hours. Therefore, one dressing per day fully provides a therapeutic effect.

Physiotherapy is started on the 2nd day after the surgical treatment of the wound. Before the procedures in the first phase (if necessary and in the second phase) on the open wound (not through the bandage), it should be cleaned of purulent masses. In the first phase of the wound process, bactericidal, anti-inflammatory, necrolytic and immunostimulating methods are used to treat the inflammatory syndrome; In the second phase, the same methods are used, with the exception of necrotic ones. Analgesic methods are used mainly during the first, rarely the second phase of the wound process. Reparative-regenerative and vasodilating methods aimed at treating the syndrome of metabolic and trophic disorders are prescribed in the second and third phases, and the fibromodulating methods in the third.

Bactericidal methods: KUF irradiation, local aeroionotherapy, aeroionophoresis of antibacterial drugs, electrophoresis of antibacterial drugs, local aerosol therapy of antibacterial drugs, local darsonvalization (spark discharge), local baths with potassium permanganate.

Regeneration

In the second phase, treatment activities should mainly be aimed at strengthening the regeneration processes and protecting the wound from damage. In this phase, a strong wound barrier has already been created, the number of microbes in the wound detachment and their virulence have sharply decreased, the maturation of granulations occurs.

Treatment of purulent wounds should prevent the development of secondary infection. Apply a bandage with fish oil, vaseline oil or other indifferent ointment, which helps fill the wound with granulations and epithelization.
These tasks are answered by:
a) ointments: methyluracil, troxevasin - to stimulate regeneration; ointment on fat basis - to protect the granulation from damage; water-soluble ointments - anti-inflammatory action and protection of wounds from secondary infection.
b) herbal preparations - aloe juice, sea-buckthorn and dog-rose oil, Kalanchoe.
c) use of the laser - in this phase of the wound process low-energy (therapeutic) lasers with stimulating action are used.

To preserve and restore the function of the affected organ, indications for the use of physiotherapy, physiotherapy procedures should be extended. With a wound on the leg, recovery occurs first by slow walking.

Scarring

The stage occurs after the bottom of the wound and its cavity are filled with a granulation tissue. The tasks of the stage: accelerate the process of epithelization and scarring of wounds. For this purpose, sea buckthorn and hips are used, aerosols, troxevasin-jelly, low-energy laser irradiation. At this stage it is not recommended to use ointments that stimulate the growth of granulations. On the contrary, it is recommended to switch again to water-salt antiseptics. It is useful to dry the dressing to the surface of the wound. In the future, it should not be torn off, but only cut at the edges, as it detaches due to the epithelization of the wound. On top of this bandage is recommended to moisturize with an iodonate or other antiseptic. In this way, the wound is healed in small sizes under the scab with a very good cosmetic effect. The scar is not formed at the same time.

According to the military doctor, it is also possible to treat purulent wounds at home if the wounds are small and there are no complications.