Features of operation debridement depending on the localization of the following. For wounds of the head and face, given a good blood supply to these areas is economical destruction of tissue, and the operation can be performed at a later date with stitches. For wounds of the limbs and trunk valid in early after the injury time (8-12 hours). Economical cutting of fabrics made with the wounds of the hands. Damaged nerves, blood vessels, brain tissue are handled efficiently, sometimes limited to remove only foreign bodies, non-viable tissues. Contaminated bone edges stuck out in the wound, skyiwwt cutters, fragments are stitched on a soft cloth, limb immobilizer plaster cast or impose skeletal traction. When penetrating into the joint cavity wound in her before stitching injected antibiotics, and if contaminated swabs with antibiotics.
When the possibility of infection of the wound is left not sewn or impose provisional seams, i.e., stitch the wound, but not tied a thread to defuse the risk of infection, and more often apply delayed primary closure, i.e., sew the wound immediately, but after 2 to 4 days after the treatment, if it was found that the infection will not develop.
When narrow stripes produce their dissection; when firearms through wounds - cut first entry hole, then the output. The wound, which decided not to sew, it is advisable to wash out any antiseptic solution (3% hydrogen peroxide; the furatsilina 1 : 5000; ethacridine 1 : 1000), followed by tamponade dry gauze or oil emulsion. Dusting RAS is not recommended. Early surgical treatment of the wound is called the surgery in the first 24 hours regardless of the use of antibiotics. Early intramuscular administration of antibiotics allows you to have surgery during the second day after the injury. Such treatment of the wound referred to as "deferred" and "late"when it is made later than 24 hours. no antibiotics or 48 hours. with antibiotics.
If the wound healing is without complications primary intention, skin sutures are removed on the 6 - 16-th day after operation, depending on the nature of the intervention, the patient's age and type of illness. So, after a median chrevosechenie, the thoracotomic, amputation sutures are removed on the 10th-14th day after appendectomy on 6-7-th day. In elderly, debilitated patients, cancer patients, whose regeneration of tissues is reduced, the sutures are removed on 14-16-th day after operation.
Nurse important to know the complications that may be in the postoperative wound, so that, without losing time, inform the surgeon about their appearance. Complications include hematoma, hemorrhage, infiltration, festering wounds, wound dehiscence with prolapse of the viscera (see the Postoperative period).
During the spread of infection, in addition to conservative measures, on the evidence produced secondary surgical treatment of the wound, which is to cut wounds cut beyond the visible inflammatory changes in the excision of necrotic areas or dissection type necrotomy (see). Additional multiple incisions are made in anaerobic infections: open fabrics, deathly changed, swollen, containing gas. In some cases of severe wound infection resort to amputation. Wounds after secondary surgical treatment are treated as wound healing by second intention (see above).