{"id":770,"date":"2010-12-02T16:49:37","date_gmt":"2010-12-02T16:49:37","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/the-wound\/"},"modified":"2024-06-14T16:18:19","modified_gmt":"2024-06-14T15:18:19","slug":"the-wound","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/minor-surgery\/theoretical-background\/the-wound\/","title":{"rendered":"The Wound"},"content":{"rendered":"<hr \/>\n<p><span style=\"color: #003366;\">Before treating the <\/span><span style=\"color: #33cccc;\"><strong>wound<\/strong><\/span><span style=\"color: #003366;\">, a decision must be made about whether treatment will be performed by yourself or a specialist. History-taking and examination can help make the right decision. <strong>Decision Tree 1<\/strong> illustrates the steps involved in the decision-making process.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-769\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-tree-1-400p.jpg\" alt=\"\" width=\"400\" height=\"472\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-tree-1-400p.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-tree-1-400p-254x300.jpg 254w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong>History-Taking and Examination<\/strong><\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">First assess the patient\u2019s <span style=\"text-decoration: underline;\">general condition<\/span> with regard to vital functions.<\/span><\/li>\n<li><span style=\"color: #003366;\">Knowledge of <span style=\"text-decoration: underline;\">how<\/span> the wound occurred can help when estimating the amount of <span style=\"color: #33cccc;\"><strong>non-viable tissue<\/strong><\/span>, damage to <span style=\"color: #33cccc;\"><strong>deeper-lying structures<\/strong><\/span>, and the <span style=\"color: #33cccc;\"><strong>extent of contamination<\/strong><\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">For assessing <span style=\"color: #33cccc;\"><strong>trauma-related tissue damage<\/strong><\/span>, assume that incised wounds, penetration wounds, and abrasions cause little damage.<\/span><\/li>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Severe tissue damage<\/strong><\/span> may be expected for <span style=\"text-decoration: underline;\">lacerations<\/span>, <span style=\"text-decoration: underline;\">contusions<\/span>, <span style=\"text-decoration: underline;\">gunshot wounds<\/span>, <span style=\"text-decoration: underline;\">burns<\/span>, <span style=\"text-decoration: underline;\">fractures<\/span>, and <span style=\"text-decoration: underline;\">wounds<\/span> caused by <span style=\"color: #33cccc;\"><strong>radiation<\/strong><\/span> or <span style=\"color: #33cccc;\"><strong>electricity<\/strong><\/span>. Penetration wounds, gunshot wounds, and fractures can damage deeper-lying structures. Wounds to the chest or abdomen caused by sharp or blunt objects may damage <span style=\"color: #33cccc;\"><strong>internal organs<\/strong><\/span> (<em>even if the skin is intact<\/em>). Wounds to the extremities caused by sharp or blunt objects can severely damage <span style=\"text-decoration: underline;\">blood vessels<\/span>, <span style=\"text-decoration: underline;\">tendons<\/span>, <span style=\"text-decoration: underline;\">joints<\/span>, <span style=\"text-decoration: underline;\">nerves<\/span>, and <span style=\"text-decoration: underline;\">muscles<\/span>. <span style=\"color: #33cccc;\"><strong>Severe contamination<\/strong><\/span> may be expected for <span style=\"text-decoration: underline;\">bite wounds<\/span> caused by humans or animals. These wounds should never be treated with primary closure.<\/span><\/li>\n<li><span style=\"color: #003366;\">Wounds <span style=\"text-decoration: underline;\">older than 6 hours<\/span> should be left <span style=\"color: #33cccc;\"><strong>open<\/strong><\/span>. Deviation from this recommendation may be considered when the wound occurs in a very well vascularised area, such as the face.<\/span><\/li>\n<li><span style=\"color: #003366;\">Factors that may influence wound healing are: <span style=\"color: #33cccc;\"><strong>advanced age<\/strong><\/span>, <span style=\"color: #33cccc;\"><strong>systemic disease<\/strong><\/span>\u00a0(<em>diabetes mellitus or atherosclerosis<\/em>), a <span style=\"color: #33cccc;\"><strong>neurological disorder<\/strong><\/span>, <span style=\"color: #33cccc;\"><strong>malnutrition<\/strong><\/span>, <span style=\"color: #33cccc;\"><strong>poor vascularisation<\/strong><\/span> of the wound area (<em>front side of the lower leg<\/em>), <span style=\"color: #33cccc;\"><strong>medication use<\/strong><\/span> (<em>corticosteroids, anticoagulants, chemotherapy<\/em>).<\/span><\/li>\n<li><span style=\"color: #003366;\">Has the patient been vaccinated against tetanus?<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\">During the examination, determine the following:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Patient\u2019s general condition.<\/span><\/li>\n<li><span style=\"color: #003366;\">Extent of the wound.<\/span><\/li>\n<li><span style=\"color: #003366;\">Degree of contamination.<\/span><\/li>\n<li><span style=\"color: #003366;\">Degree of tissue damage.<\/span><\/li>\n<li><span style=\"color: #003366;\">Damage to deeper-lying structures.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong>Approach<\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\">Normally, a general practitioner will decide to treat a wound themselves if there are no complicating factors present. This implies the following:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Wounds with <span style=\"color: #33cccc;\"><strong>little tissue damage<\/strong><\/span>, i.e. damage to deep-lying structures is not suspected, and little contamination can be treated with <span style=\"text-decoration: underline;\">debridement<\/span> and <span style=\"text-decoration: underline;\">primary wound closure<\/span>.<\/span><\/li>\n<li><span style=\"color: #003366;\">The same type of wound with heavy contamination or older than six hours can be treated with <span style=\"text-decoration: underline;\">debridement<\/span>; the wound is left open. Delayed primary closure may occur as necessary after 4-7 days.<\/span><\/li>\n<li><span style=\"color: #003366;\">Wounds involving <span style=\"color: #33cccc;\"><strong>high tissue loss<\/strong><\/span>, suspected or confirmed <span style=\"color: #33cccc;\"><strong>damage to deep-lying structures<\/strong><\/span>, or areas of <span style=\"color: #33cccc;\"><strong>cosmetic importance<\/strong><\/span> (<em>wounds traversing the skin and lip<\/em>), should be handled by a specialist. The fact that leaving a wound open is a safe treatment approach is often overlooked. Primary wound closure is associated with a higher risk of infection, particularly when the wound is heavily contaminated. Performing primary closure on an infected wound yields a more prominent scar than what would be expected had the wound been left open.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><strong>Follow-Up Care<\/strong><\/span><\/p>\n<p><span style=\"color: #003366;\">After a wound is closed, a <span style=\"color: #33cccc;\"><strong>wound covering bandage<\/strong><\/span> or a <span style=\"color: #33cccc;\"><strong>pressure bandage<\/strong><\/span> must be placed over the wound. The wound covering bandage can be removed after <span style=\"text-decoration: underline;\">four days<\/span> (<em>after two days, a clean, closed wound is no longer accessible by bacteria<\/em>). The pressure bandage must be removed within <span style=\"text-decoration: underline;\">24 hours<\/span>.<\/span><\/p>\n<p><span style=\"color: #003366;\">Patients must be informed of which complications may occur, measures they must take, and where they can seek help.<\/span><\/p>\n<p><span style=\"color: #003366;\">Patients are advised to return immediately if they experience wound <span style=\"color: #33cccc;\"><strong>redness<\/strong><\/span>, severe and\/or throbbing <span style=\"color: #33cccc;\"><strong>pain<\/strong><\/span>, or <span style=\"color: #33cccc;\"><strong>fever<\/strong><\/span>. If infection occurs, treatment options are a <span style=\"text-decoration: underline;\">wet compress<\/span> or <span style=\"text-decoration: underline;\">removal<\/span> of <span style=\"text-decoration: underline;\">one<\/span> or <span style=\"text-decoration: underline;\">more sutures<\/span> to <span style=\"text-decoration: underline;\">drain the wound<\/span>, depending on the severity of the infection.<\/span><br \/>\n<span style=\"color: #003366;\">This means that the patient must possess a letter describing the treatment that he has undergone, in the event that follow-up care is provided elsewhere or by another colleague (<em>weekend service<\/em>). Arrangements should also be made with regard to <span style=\"color: #33cccc;\"><strong>pain control<\/strong><\/span>, and instructions should be given on using the operated or injured body part.<\/span><\/p>\n<p><span style=\"color: #003366;\">To promote wound healing, <span style=\"color: #33cccc;\"><strong>relative inactivity<\/strong><\/span> is recommended. The extent of the wound or a tendency for bleeding may necessitate temporarily immobilising or elevating the affected body part (<em>sling<\/em>).<\/span><\/p>\n<p><span style=\"color: #003366;\">If necessary, the patient should receive <span style=\"color: #33cccc;\"><strong>tetanus prophylaxis<\/strong><\/span>. Written proof that the patient received tetanus prophylaxis should be given to the patient, and it should be noted in the patient\u2019s file.<\/span><\/p>\n<p><span style=\"color: #003366;\">The timing of suture removal depends on the wound site. <span style=\"text-decoration: underline;\">After 10 days<\/span> for wounds to the <span style=\"color: #33cccc;\"><strong>torso<\/strong><\/span> or <span style=\"color: #33cccc;\"><strong>extremities<\/strong><\/span> and <span style=\"text-decoration: underline;\">after 5 days<\/span> for wounds to the <span style=\"color: #33cccc;\"><strong>face<\/strong><\/span> and <span style=\"color: #33cccc;\"><strong>neck<\/strong><\/span>.<\/span><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Before treating the wound, a decision must be made about whether treatment will be performed by yourself or a specialist. History-taking and examination can help make the right decision. Decision Tree 1 illustrates the steps involved in the decision-making process. History-Taking and Examination First assess the patient\u2019s general condition with regard to vital functions. Knowledge [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[75],"tags":[146],"class_list":["post-770","post","type-post","status-publish","format-standard","hentry","category-theoretical-background","tag-minor-surgery"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The Wound - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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