PHO wounds (primary surgical treatment): a set of tools, medicines

Wound – tissue damage by mechanical means in the presence of violations of the integrity of the skin. The presence of a wound, not a bruise or hematoma can be identified by such signs as a pain, dehiscence, bleeding, impaired function and integrity. Gastrectomy for gastric cancer is performed in the first 72 hours after injury, if there are no contraindications.

Varieties of wounds

Each wound is a cavity, the sides and bottom. Depending on the nature of the damage, all the wounds are divided into puncture, cut, chopped, bruised, bitten and poisoned. During gastrectomy for gastric cancer in the subject. Because of the nature of the injury depend on the features of first aid.

• Puncture wounds are always applied to sharps, e.g. needle. A distinctive feature of damage is a lot of depth, but small injuries of the skin. In view of this, you must make sure there is no damage to vessels, organs or nerves. Puncture wounds are dangerous because of the lack of symptoms. So in the presence of a stomach wound there is a chance of liver damage. It's not always easy to notice when carrying out a PHO.
• Incised wound is applied with a sharp object, so the destruction of tissue is small. At the same time, the gaping cavity are easy to inspect and carry out PHO. Such wounds are well-treated, and healing is quick and without complications.
• Chopped wounds appear due to the harm severe, but a heavy object such as an axe. The damages are deep, characterized by the presence of a wide hiatus and injury to neighboring tissues. Because of this reduced ability to regenerate.
• Bruised wounds appear when a blunt object. These injuries are characterized by the presence of many damaged tissues heavily soaked with blood. When performing gastrectomy for gastric cancer should be aware that there is the likelihood of suppuration.
• Bite wounds dangerous infection from saliva of the animal and sometimes human. There is a risk of acute infection and the appearance of the rabies virus.
• Poisoned wounds usually occur in the presence of a snake bite or spider.
• Gunshot wounds differ in the type of the used weapon, characteristics of damage and trajectories of penetration. The probability of infection.

When performing gastrectomy for gastric cancer an important role plays the presence of suppuration. Such injuries are purulent, svezheizgotovlennyj and aseptic.

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The purpose of the PHO

Primary surgical treatment required to remove harmful microorganisms which got into the wound. To do this, cut off all the damaged dead tissue and blood clots. Then sutured and drainage is performed if necessary.

The Procedure is needed when the damaged tissue with uneven edges. This requires a deep and contaminated wounds. Damage large blood vessels, and sometimes bones and nerves also requires surgical work. PHO is carried out simultaneously and comprehensively. Surgery is necessary for the patient up to 72 hours after application of the wound. Early PHO is held in the first days, holding on the second day – a delayed surgical intervention.

Tools for PHO

Procedures For the primary processing of a wound requires a minimum of two copies of the set. Change them during the operation, and after the dirty stage – dispose:

• Clamp "Forceps” straight, which is handled by the operating field;
• Pointed scalpel, pushisty;
• Linen hoe used for holding dressing and other materials;
• Clamps Kocher, Billroth and “fly” are used to stop bleeding, when performing gastrectomy for gastric cancer they are used in a huge number;
• Scissors, they are straight, but also curved in the plane or edge in a few instances;
• Probes Kocher, fluted and bellied;
• Set of needles;
• Needle holder;
• Tweezers;
• Hooks (a few pairs).

Surgical kit for the procedure includes sutures, hypodermic needles, syringes, bandages, gauze balls, rubber gloves, all kinds of tubes and tissues. All items that need for the PHO – suture and bandaging sets, tools, and medicines intended for the treatment of wounds – laid out on the surgical table.

Required medications

Primary surgical processing of wounds is not without special medicines. Most often used are:

• 70% alcohol;
• 3% hydrogen peroxide solution;
• The 1% solution yodopiron or 0.5% solution of chlorhexidine digluconate;
• 10% NaCl solution;
• 0,25% - 0,5% solution of novocaine.

Stages PHO

Primary surgical treatment is carried out in several stages:

1. Inspection of the wound and its subsequent antiseptic treatment.
2. Removal of damaged tissue, foreign bodies, bone fragments. Performed the dissection of the wound as necessary.
3. Stop the bleeding.
4. Drainage.
5. Stitching.

How to do PHO

For surgerythe patient is placed on the table. It depends on the deployment of the wound. The surgeon should be comfortable. Is the toilet of the wound, is handled by the operating field, which is delineated sterile disposable linen. Then primary tension aimed at healing the existing wounds and injected anesthesia. In most cases, surgeons use a method Vishnevsky – injected 0.5% solution of novocaine at a distance of two centimeters from the edge of the cut. The same solution is injected from the other side. With proper patient response on the skin around the wound there is a "citric crust". Gunshot wounds often require the introduction of the patient General anesthesia.

The edges of the damage up to 1 cm hold clip Kochhar and removed as a single unit. When performing procedures on the face or fingers cut off niznegorodskaya the fabric, and then imposed a tight seam. Replacement of gloves and used instruments.

The Wound is washed with chlorhexidine and carried out her inspection. Puncture wounds with small but deep incisions, dissect. If the damaged region of the muscle, they are removed. They do the same with bone fragments. Further, hemostasis is performed. The inner part of the wound treated with a first solution and then with antiseptic agents.

The Treated wound without symptoms of sepsis, primary suture tightly hand-stitch and cover aseptic bandage. Joints perform uniformly capturing all the layers in width and depth. It is necessary that they touch each other, but not massed. When performing the work necessary to obtain cosmetic suture after healing.

In some cases, the original seams do not overlap. Incised wound could be more serious damage than it seems at first glance. When in doubt, the surgeon uses a primary-deferred seam. This method is used if a wound was infected. Suturing is carried out until the fatty tissue, and the suture is not tightened. After a few days of observation, the wound is sewn up to the end.

The Wounds from the bites

PHO wounds, bitten or poisoned, has its differences. Bites are not poisonous to animals, the probability of infecting rabies. At an early stage, the disease is suppressed rabies serum. Such wounds in most cases become purulent, so PHO is trying to pull. When the procedure is superimposed primary-deferred seam and apply antiseptic medicines.

The Wound caused by the bite of a snake, requires the imposition of a tight tourniquet or bandage. In addition, the wound frozen with novocaine or apply cold. To neutralize the poison introduced anti-typhoid serum. Bites of spiders are blocked by potassium permanganate. Until then squeezed out the poison, and the wound treated with an antiseptic.

Complications

Nematulla treatment of the wound with antiseptics leads to suppuration of wounds. Wrong painkiller, as well as causing further injury causing patient concern due to the presence of pain.

Rude attitude to the tissues, poor knowledge of anatomy lead to damage to major blood vessels, internal organs and nerve endings. Inadequate hemostasis causes inflammatory processes.

It is Very important that primary surgical treatment of wounds was conducted by a specialist according to the rules.