tailieunhanh - Ebook Emergency medicine procedure (2nd edition): Part 2

(BQ) Part 2 book "Emergency medicine procedure" presents the following contents: Skin and soft tissue procedures, neurologic and neurosurgical procedures, anesthesia and analgesia, obstetrical and gynecologic procedures, genitourinary procedures, ophthalmologic procedures, otolaryngologic procedures, dental procedures, podiatric procedures, miscellaneous procedures. | SECTION Skin and Soft Tissue Procedures 7 92 General Principles of Wound Management Lisa Freeman Grossheim INTRODUCTION An acute wound can be defined as an unplanned disruption in the integrity of the skin including the epidermis and dermis. The goals of wound management are to restore tissue continuity and function minimize infection repair with minimal cosmetic deformity and be able to distinguish wounds that require special care. The principles of wound management should be emphasized over the repair technique. Appropriate wound management prior to approximating the wound will allow it to heal with minimal complications. This includes wound cleansing debridement of the wound edges wound approximation and prevention of secondary injury. HEALING OF WOUNDED TISSUE PHASES OF WOUND HEALING The response of tissue to an injury is described in three phases. The first phase is coagulation and inflammation. The second phase is the proliferative phase. The final phase is the reepithelialization or remodeling phase. Phase I consists of coagulation and inflammation. It occurs in the first 5 days. This phase is also known as the vascular phase. A fibrin clot forms a transitional matrix that allows for the migration of cells into the wound site over a period of 72 hours. Inflammatory cells . neutrophils monocytes and macrophages kill microbes prevent microbial colonization break down soluble wound debris and secrete cytokines. The cytokines signal synthetic cells such as fibroblasts to initiate phase II. Most sutured wounds develop an epithelial covering that is impermeable to water within 24 to 28 hours. Phase II is the proliferative phase. It occurs during days 5 to 14 after the injury. Fibroblasts proliferate and synthesize a new connective tissue matrix that replaces the transitional fibrin matrix. Granulation tissue consisting of fibroblasts immature connective tissue epidermal cells that have migrated and abundant capillaries forms within the wound. Fibroblasts .