PCW of wound - primary surgical treatment

Author: Surgeon Denisov M.М.

Primary surgical treatment of a wound (PCO) is a series of surgical manipulations aimed at preventing wound infection and creating the necessary conditions for the most effective wound healing.

As a rule, the PEF is composed of several stages:

· Visual inspection of the wound

· Thorough wound treatment

· Wound dissection

· Excision within healthy tissues

· Cessation of bleeding

· Wound closure and drainage

Visual inspection of the wound is necessary to determine the degree of damage, the type of wound and its contamination. Based on the obtained data, the plan for its sanitation is modeled.

Careful treatment of the wound as an independent manipulation is carried out in cases of minor injuries (for example, superficial cut wounds). To implement the event, the surgeon cleans the skin around the wound from contamination. For these purposes, use a cotton swab that is moistened with an alcohol solution or a septocid. After cleaning the edges of the wound are smeared with alcohol solutions of iodine (iodonate, iodinol). Asking the question, what to treat the wound , you can use the above drugs, as well as chlorhexidine and other antiseptics. At the end of the procedure, an aseptic bandage is applied to the wound surface. Such manipulation is carried out in all medical institutions.

If there is no possibility to conduct a sufficient wound toilet, the dissection of the edges is carried out. Depending on the general condition of the patient, such manipulation is performed under local (infiltrative) or general anesthesia. It is important to use 3% hydrogen peroxide. Due to its pharmacological properties, this preparation decomposes to active oxygen when interacting with tissues, leading to the formation of a foam that acts as an adsorbent for microorganisms and contaminants in the wound. After treatment with peroxide solution, visible foreign bodies are removed from the wound with tweezers.

The excision of the wound within the healthy tissue is called complete. Partial is called in the event that the destruction of crushed or dead tissue occurs. Wounds localized on the face, hands, as a rule, do not dissect because of a large cosmetic defect. It is also contraindicated to excise the edges of the wound, if they determine the presence of large vessels and nerve trunks.

After performing all the manipulations, the bleeding stops by ligation of large vessels and cauterization (coagulation) of smaller ones. If large-caliber vessels are damaged, a special vascular suture is applied to them.

The last stage of primary surgical treatment is suturing the wound tightly. Treatment of purulent wounds has its own distinctive feature. It consists in the absence of the need for suturing the wound, the edges of the wound are simply pulled together by ligatures, but it is mandatory to create ways of outflow of the wound to be separated, in order to avoid repeated suppuration. This manipulation was called drainage. Drainage is a narrow tube, one end is in the wound, the other - outside it. Also active drainage can be used, for injecting antiseptic agents into the wound and pumping out the exudate.

At the discretion of the surgeon, in the event of a risk of developing a wound infection, and subsequently sepsis, antibiotic therapy of up to 7-10 days is prescribed. As a rule, antibiotics of a wide spectrum of action are used to suppress the conditionally pathogenic flora.