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In the course of treatment should be provided factors of local and general effects on the body . Under necrotisation importance is attached to the factors that help cleanse the wound. Necessary to ensure peace ( immobilization ) , the introduction of antibiotics and antiseptics topically to the wound , and the oral or intramuscular , strengthen processes of melting of necrotic tissue in the wound , applying bandages with hypertonic saline solution of 5-10%. Suppurative focus should be opened and drained .
Postoperatively attention outflow of pus from the wound , keeping the overall immunobiological resistance. Apply bandages and antiseptic with hypertonic solutions.
In the step of granulating the rest of the wound surface must be provided sparing regime dressings , creating conditions for the preservation formed granulation . Dressings used ointment bases . To save and restore functions of the affected organs should be expanded indications for use of physical therapy , physiotherapy. When filling in the wound granulation , no they necrotic films wound edges can be approximated strips or adhesive tape on them imposed secondary seams .
Abscess, abscess
Abscess, abscess
- This is a limited collection of pus in the tissues.
Most often, an abscess formed in the subcutaneous tissue , at least - in the tissue located deeper, and other organs. With the development of an abscess expressed the general reaction of the organism to inflammation. The clinical course is different . Sometimes the formation of pyogenic membrane absorption process decreases , so symptoms of intoxication subsides . Later during the purulent process may pass through self-healing ( very rare ) . In these cases, the microbes in the abscess cavity die , pus becomes sterile and gradually resolves . A transition to the chronic form. In these cases, the microbes in the abscess cavity die , pus becomes sterile and gradually resolves , signs of acute inflammation disappear, but retained slight swelling , pain , symptom fluctuations .
Management of patients :
starting with abscess , until the formation of purulent cavities appointed rest, warm ( hot compress , heating pad , ultraviolet irradiation , UHF , etc.). When the inflammatory edema and hyperemia applied cold. Prolonged use of cold inadvisable as may occur anemizatsiya tissue violation of their trophics , expanding the zone of necrosis and reduced local tissue resistance . Appointed by excessive drinking, high-calorie food , vitamins. Conducted intravenous administration of glucose , saline , blood transfusion, plasma substitutes .
gangrene
gangrene
- Necrosis , which developed in vivo.
nonspecific
specific
dry
wet
Causes of death are the direct destruction of their traumatic agent or circulatory disorders . Promote the development of necrosis of exhaustion, anemia, vitamin deficiency, infection. By origin allocated nonspecific and specific gangrene. gangrene developed as a result of large vessel injury , prolonged use of a tourniquet , infringement , torsion, internal organs , thrombosis, embolism, large vessel , thermal or chemical trauma, and others are developing gangrene in syphilis , diabetes, occlusive disease . The clinical course is isolated and gangrene .
(" Marbled skin ")
Dry gangrene develops in slowly progressive impairment of circulation in malnourished , dehydrated patients. There are strong pain ( ischemic nature) , pale limb becomes cold to the touch , pulse is not detected . Necrosis extends from the peripheral regions of upward. With a favorable course of the process at the border of healthy tissue necrosis and gradually developed demarcation shaft . Phenomena of intoxication expressed slightly .
" Marble ."
Wet gangrene develops at a rapid impairment of circulation ( embolism , wound vessel) . Increases sharply edema , pulse is not detected , the skin becomes pale , Soon there network varices , dark red spots , blisters as a result of detachment of the epidermis filled sukrovichnye content. Tissue decay , turning into a stinking mass of dirty gray- green color . Signs delimitation process are absent. General condition is serious , high body temperature , marked pain in the affected limb , lethargy , confusion . Tongue dry . Pulse frequent , small , blood pressure is reduced . Process progresses rapidly and is complicated by sepsis .
Conservative treatment is the appointment of rest, warming aseptic dressings , holding novocaine blockades . Appointed anticoagulants, antibiotics , detoxifying agent.
Operative treatment of dry gangrene is to conduct necrectomy when wet gangrene - immediate amputation within normal tissues .
" Symptom razors ."
Gas gangrene (gas infection anaerobic infection ) . Necrosis that develops as a result of contact with the wound of anaerobic infections . In the wound appear pain, bloating , it seems that the bandage is too narrow . Rapidly developing tissue edema , cyanosis, bronze appearance spots. When a cluster of gas marked crepitus , Rana lifeless with dirty- gray coating on the skin - phlyctenas putrid smell. General condition is serious , earthy skin color. Marked lethargy, apathy, and sometimes exciting. The pulse quickens . Different forms of gas gangrene following :
• edematous - proceeds with phenomena pronounced edema and toxicity ;
• emphysematous - dominated by gas formation ;
• Mixed - severe swelling to form a significant amount of gas;
• necrotic - occurs with symptoms of necrosis ;
• abscess - proceeds with the development of cellulitis ;
• tkanerasplavlyayuschayasya - characterized by severe and rapid flow .
lightning , stormy
slow .
Course of the disease - or adverse effects of accession has aerobic infection , which often leads to the development of sepsis.
Management of patients :
Conservative treatment consists of applying a mixture protivogangrenoznyh sera. Serum administered intravenously . One therapeutic dose is 5 - 10 prophylactic doses. For the prevention of anaphylactic shock serum is injected under anesthesia , intravenous use of antihistamines. Along with the use of intravenous of intramuscular 5-8 prophylactic doses to create a depot in the body serums. Non-specific treatment includes measures to reduce intoxication.