Treatment of common wounds:
1, clean wounds are disinfected with iodophor, which is less stimulating and more effective; for clean, nascent granulation wounds, they can also be covered with petroleum jelly gauze to reduce patient pain during dressing changes and to reduce tissue fluid exudation and loss.
2.Wounds with rich blood supply and small chance of infection can be moistened with saline briefly and wrapped with sterile excipients.
3, for wounds with skin defects, the defect area is repeatedly rinsed with saline, the surrounding area can be routinely disinfected with iodophor, after disinfection, covered with saline gauze or petroleum jelly gauze, saline gauze is good for keeping the wound fresh and dry, petroleum jelly gauze is good for the growth of granulation of the wound surface.
4, the principle of infected or contaminated wounds is to drain the pus, if necessary chap the sutures, expand the wound, thorough drainage, repeated flushing with hydrogen peroxide and saline in the wound, necrotic tissue should be given for debridement, you can also fill the wound with antibiotic gauze, the wound is best disinfected with iodine twice alcohol three times deiodination around the wound. Of course, infected wounds should be changed every day.
In addition, when changing medication for septic incisions, don’t mind the bad smell, make sure to carefully wipe off the pus moss at the incision, and don’t dare to touch the incision because of the patient’s pain, there should be slight blood oozing out after the pus moss is removed, which will help the incision heal as soon as possible!
5, decubitus ulcer, septic osteomyelitis and other infected wounds: iodophor disinfects around the incision, while the incision is flushed with hydrogen peroxide, saline, and covered with gentamicin dressing.
6.For osteomyelitis with bone outgrowth the dressing change should be diligent in the first place, because there is a lot of exudation, and the dressing should be more. During the dressing change, necrotic tissue should be removed at any time, and gauze can be placed in the medullary cavity. The empirical method is to first rinse the trauma with saline, then with 0.1% iodine, then with hydrogen peroxide, and finally with Qingda gauze wet and covered with a dressing. When the trauma surface has fresh granulation and less exudation, perform surgery to remove the dead and sclerotic bone, use a suitable musculocutaneous flap to cover the trauma surface, external fixation frame for external fixation, and then perform bone lengthening after the flap becomes viable.
7, open fracture external fixation of patients followed by the first iodophor disinfection (while cleaning the removal of necrotic tissue), followed by the use of hydrogen peroxide disinfection, then saline rinse, and finally furacilin filling to cover the wound surface. Waiting for its granulation growth, line free skin flap cover.
8, fat liquefaction of the incision, in fat-rich areas prone to fat liquefaction, at this time extensive open incision (fat liquefaction of the area all open), culture + drug sensitivity, strengthen the drug change. Such an incision should be changed for a long time, in order to shorten the time, after the initial disinfection in the local subcutaneous injection of gentamicin, placed glucose powder into the incision, daily change of medication, to be less exudation from the wound after oil gauze to stimulate the growth of granulation, fresh after the second phase of suture or butterfly tape pulling together.
9, long ulcerated wounds, to use Chinese herbal medicine change. Chinese medicine dressing change has its uniqueness, but usually there is no sterile concept. For example, for refractory sinus tracts (such as after brain surgery, after heart bypass surgery or sinus tracts caused by chronic osteomyelitis, usually early with eighty-two dan or nine one dan + red oil ointment, lifting rot and removing pus, and late with raw muscle san + red oil ointment closure, the effect is very good, even if the Pseudomonas aeruginosa or drug-resistant Staphylococcus aureus infection can be well cured.
10.For contaminated oily wounds, we here use turpentine to wash away the oil stains.
11.For old granulation wound, such granulation tissue regeneration ability is poor (dark red color, not fresh, uneven height, sometimes old bleeding appearance), the surrounding tissue is not easy to heal, scrape the surface granulation tissue with a scraper or cut out, so that it bleeds, reveal fresh granulation, external rubber ointment (this is the Chinese medicine to decompose the muscle, Western medicine will be flushed with hydrogen peroxide to achieve the purpose of decomposition). If there is pus, attention should be paid to the presence of pus cavities or sinus tracts, and the change in the patient’s body temperature should be noted.
12, for Pseudomonas aeruginosa infected wounds, characterized by pus is light green, there is a special sweet fishy odor, if the wound surface crust, pus accumulation under the scab, there is necrotic tissue, to remove the scab, pus and necrotic tissue. Burn trauma early green pus infection can be cut scab implants. Also available 1% to 2% phenoxyethanol wet dressing, or 0.1% gentamicin, 1% silver sulfadiazine, 10% methanesulfamilone and other solutions wet dressing. Trauma such as small available 3% acetic acid, 10% chloral hydrate and other solutions wet dressing.
13, reimplantation surgery or anastomosis of the flap surgery is best to use a furacilin solution similar to the body temperature to change the medication, with alcohol to change the medication can be scolded; finger dressing gauze should avoid ring wrapping, local best to fill with shredded gauze.
14, for difficult to heal sinus tracts such as after brain surgery, after heart bypass surgery or sinus tracts caused by chronic osteomyelitis, usually early with eight two Dan or nine one Dan + red oil cream, lifting rot and removing pus, and later with raw muscle san + red oil cream closure, the effect is very good, even if the Pseudomonas aeruginosa or drug-resistant Staphylococcus aureus infection can be well cured.
15.For old granulation wound: such granulation tissue has poor regeneration ability (dark red color, not fresh, uneven height, sometimes old bleeding appearance), the surrounding tissue is not easy to heal, scrape or cut the surface granulation tissue with a scraper to make it bleed, reveal fresh granulation, apply rubber high externally (this is the Chinese medicine to decay and regenerate the muscle, western medicine will flush with hydrogen peroxide to achieve the purpose of decay) if there is pus, attention should be paid to Observe the presence of pus cavity or sinus tract, and pay attention to the change of patient’s body temperature.
Caution:
1, aseptic one-stage wound dressing change is usually done at 24 hours and 72 hours to routinely observe local swelling and exudation.
2, open wounds for 24, 48, 72 hours after surgery for three consecutive days of drug changes, pay special attention to easy to appear hematoma or drainage situation in a timely manner to exclude dangerous situation is more critical.
3, orthopedic trauma more often seen infected trauma is skin necrosis, decubitus ulcer trauma, hypertonic saline is generally used in a certain period of time, heavy infection, more exudate trauma, can quickly reduce the trauma and granulation tissue edema, reduce exudation.
4, Reimplantation surgery or anastomotic vascular flap surgery can best be changed with furacilin solution similar to body temperature, finger change gauze should avoid ring wrapping, and localized gauze is best filled with shredded gauze.
5, for large area trauma, first of all, pay attention to clear the wound, for the already necrotic tissue including necrotic tendons and vascular tissue do not appease, strive for several times in the change of medicine, the boundary once obvious then decisively removed. Reluctantly left, will only delay the growth of granulation, or even cause infection.
6.For the wound that has cleared most of the necrotic tissues, pay attention to the growth of the granulation, the granulation tissue itself has the ability to resist infection, if there is no obvious exudation, then do not use antibiotics or other medication changes, only disinfect the skin of the trauma edge with iodine volts, and cover it with wet saline gauze.
7, oil gauze should not be put on the trauma, it should be on the saline gauze to prevent the saline from evaporating too quickly.
8, there is an infection of the trauma to pay attention to do a bacterial culture + drug sensitivity before changing the medicine, so as to avoid later passive.
Commonly used drugs for medication change:
1.Saline:
It has the function of improving the nutrition of granulation tissue and adsorbing the secretion of planar surface, and has no adverse stimulation to granulation tissue. Isotonic saline cotton balls and gauze are used for cleaning the wound surface, wet dressing of the wound surface and filling the pus cavity; isotonic saline solution is used for flushing the wound cavity; 3% to 10% saline has a strong dehydrating effect and is used for the wound surface with obvious granulomatous edema.
2.3％ hydrogen peroxide:
Released oxygen by decomposition after contact with tissues, with bactericidal effect. Used for flushing trauma wounds, *** or malodorous wounds, especially for anaerobic bacterial infections.
3.0.02% potassium permanganate solution:
Decompose and release oxygen slowly, but the effect is long-lasting, with cleaning, deodorizing, antiseptic and bactericidal effects. Used for washing rotten and foul-smelling, infected wounds, especially for suspected anaerobic bacterial infection, anal and perineal wounds. Clinically, 1:5000 solution is often used for wet dressing.
4. 0.1% Ravnol
Has antibacterial and antiseptic effects. Used for cleaning and wet dressing of infected wounds.
5.Yaozuo (bleaching powder, boric acid) solution:
With sterilization, antiseptic deodorization, dissolve the role of necrotic tissue. It is used for cleaning and wet dressing of wounds with pus and rotting dead tissue and bad smell. This preparation should be kept airtight and protected from light, and should not be left for a long time, and should not be placed for more than one week. Large wounds should not be applied to avoid absorbing too much chloride ions.
6.Polyvinyl pyridone iodide (PVP-I):
It is a new type of bactericide, effective for bacteria, fungi and budding cells. 0.05%~0.15% solution is used for mucous membrane, wound surface and pus cavity flushing; 1% solution is used for dressing sterile incision; 1%~2% solution is used for wet dressing infected wound, most suitable for chronic lower limb ulcer and cancerous ulcer.
7.Antibiotic solution:
Commonly used are 0.5% neomycin solution, 0.16% gentamicin, 0.5% chlortetracycline, 2% bacitracin, 2% ~ 5% chlortetracycline and other solutions for contaminated wounds awaiting second-stage suturing, larger wounds (such as burns) before wound implantation wet dressing, dressing should be changed once a day. Chloramphenicol drops are directly implanted into infected wounds, 21 grains per lcm, once a day.
8.1%～2% phenoxyethanol solution:
It has bactericidal effect on Pseudomonas aeruginosa and has the best effect, using continuous wet dressing on the traumatic surface.
9, 0.01% ~ 0.05% Neosporin and 0.02% chlorhexidine solution:
Field in wound cleaning, the latter irrigation incision better than the former.
10.10％ garlic solution:
It has the effect of sterilization and enhancement of tissue cell phagocytosis, and has better effect on Staphylococcus aureus infection.
11.2-4% methyl violet (gentian violet) solution:
Has bactericidal and astringent effects. Used for the disinfection of superficial skin or mucous membrane ulcers, and promote the healing of nodules.
12.Pure carbolic acid solution:
With corrosion, sterilization effect. Use pure carbolic acid solution swab to cauterize anal fissures and chronic sinus tracts, so that the unhealthy granulation tissue necrosis off to promote healing. After the use of alcohol swabs to wipe to neutralize it, and then wipe with isotonic saline swabs.
13.10％～20% silver nitrate solution:
Used to cauterize anal fissures, chronic sinus tracts and corrosive overgrowth of granulation tissue, which needs to be wiped with isotonic saline swabs after use.
14.Oil gauze:
With drainage, protection of the trauma, dressing is not easy to dry and prolong the role of drug change time. If the traumatic discharge is small, it can be changed once in 2 to 3 days.
Commonly used are.
①Vaseline gauze.
② cod liver oil gauze: with nutrition and promote the role of granulation, epithelial growth, etc., for slow healing wounds.
15.Powder and ointment:
(1) iodoform gauze: with the role of anti-inoculation, antiseptic, astringent, deodorization and promote the growth of granulation. Used for chronic sinus tract with glandular secretion, such as anal fistula, tuberculosis lesions after the removal of the wound. Iodoform is toxic and should not be used for a long time.
(2) 10%-20% ichthyolite ointment: has anti-inflammatory and decongestant effect, used for early abscesses.
(3) 10% zinc oxide ointment: applied to the skin surface, has the effect of protecting the skin from erosion of secretions, commonly used in the skin around intestinal fistula, biliary fistula, etc.
(4) Streptomycin ointment: applied externally on gauze, used for tuberculous wounds.
(5) 2% polyvinyl pyridone iodine ointment: used for the treatment of burns, chronic ulcers, satisfactory results.
(6) Bactrim ointment: used for infected wounds.
16.Chinese medicine:
Such as red oil ointment, raw muscle, raw muscle yu red ointment, purple flower burn ointment, moist burn ointment, big green ointment, etc., with pain relief, plucking poison and raw muscle, drainage of pus and decay.
Iodine and alcohol can only be used in places where the epidermis is intact. And iodophor is not suitable to be used in places where sebum is abundant. Glucose plus insulin is to provide nutrition for the traumatic granulation, hypertonic saline has the effect of dehydrating the edematous granulation, saline only plays the role of wet dressing, granulation growth is too high above the skin surface to use silver nitrate or other corrosion. The principle of changing the medication is to clarify the purpose of the surgical change, and what to use for the change is based on the wound situation.