Wounds traumatology. Wounds and wound infection

Every person has experienced trauma in their life. They can occur both at home and during work. Various objects and phenomena can damage the body. In order to properly assist an injured person and provide adequate treatment, you initially need to know what types of injuries exist, when and how they occur, and what to do first when they occur.

What is trauma?

Trauma is the impact of the environment or external factors on human tissues and organs or on the entire body in general. The human body responds to this influence with a number of anatomical and physiological changes, accompanied by a local or general reaction. Trauma can affect not only the integrity of organs and tissues, but also their functionality.

There is also such a concept as “injury”, which is understood as a set of injuries that are repeated under the same conditions for the same population group over the same time period. This is a statistical indicator that provides an assessment of a particular type of damage in a certain population group. The injury rate allows you to analyze the epidemiology of various types of herbs and select the best options for prevention.

Types of injuries

The classification of injuries is quite diverse; injuries can vary depending on the factor that provoked them and the degree of damage to various tissues.

First, let's look at the main categories of injuries depending on the nature of the damage and the factor that caused them:

• mechanical. They are received from a fall or from an impact, and soft and hard tissues of the body can be damaged to varying degrees;
• thermal. They are obtained when the body is exposed to high and low temperatures. These can be thermal burns (if the body is exposed to high temperatures) or frostbite (if the body is exposed to low temperatures). The second version of thermal damage is more dangerous because it has a latent period when the body gives too weak signals about the existing problem;
• electric. A person can receive such damage from a lightning strike or technical electric current. Thermal energy can cause serious burns;
• chemical. Damage can be caused by organic acids, alkaline compounds, salts of heavy metals;
• radial The body is affected by ionizing radiation or radiation;
• biological. Damage can be caused by various infections, viruses, bacteria, toxins, allergens and poisons;
• psychological. This is a special injury that is quite difficult to classify. It can be obtained during severe and prolonged experiences, as a result of which a painful reaction is observed from the vegetative and mental spheres.

The most extensive type of lesions are mechanical, so we will consider their varieties in more detail.

Mechanical injuries

The classification of injuries resulting from mechanical force is the most extensive:

• operating room It is obtained during surgery;
• random. Most often, a person receives it through his own fault or due to circumstances beyond his control;
• generic Women receive such injuries during childbirth;
• military Receiving damage to the body during combat operations.

There is another classification of damage resulting from exposure to mechanical factors. Such injuries are:

• direct (when a traumatic force is applied to a specific place) and indirect (when damage occurs close to the place where the force was applied);
• multiple and single;
• closed (when the integrity of the skin and mucous membranes is preserved) and open (when the mucous membranes and other organ tissues are torn).

The following types of damage can occur as a result of mechanical injuries:

• abrasions. With such damage, the integrity of the upper skin layer is compromised, and lymphatic or blood vessels may be affected. At first, abrasions have a wet surface, which quickly becomes covered with dried blood and plasma. The crust falls off over time, leaving a lighter area of ​​skin in its place. Complete healing of the abrasion occurs after 1-2 weeks;
• bruise. This type is formed due to rupture of blood vessels. The blood that spills out of them is visible through the superficial layer of skin, which gives the bruise a blue-red hue. The color changes over time, from purplish blue to greenish yellow. The duration of the recovery period for such injuries depends on many criteria and varies from person to person. The speed of healing is affected by the depth, size and location of the bruise;
• With dislocations, the bones in the joints are displaced. More often, dislocations occur in the joints of the upper extremities. Additionally, soft tissue rupture may occur;
• fractures. With such damage, the integrity of the bones is damaged. Additionally, rupture of nearby tissues, damage to blood vessels, muscles and hemorrhage occurs. Fractures can be located inside soft tissues, then they are called closed, but if during a fracture the skin ruptures and the bone fragment comes into contact with the environment, the fracture is open.

Another fairly extensive type of mechanical damage is wounds. They are very dangerous for human health, since when the integrity of the tissue and mucous membranes is damaged, significant blood loss and infection can occur on the wound surface.

Wounds are classified depending on the conditions of their occurrence:

• cut. They are applied with sharp cutting objects, such as knives;
• chopped. They are made into objects with a small cross-section;
• stab-cut;
• torn. Their cause is tissue overstretching;
• bitten. They are left on tissues by the teeth of people and animals;
• chopped. They are the result of exposure to a heavy sharp object, most often an ax;
• crushed. The tissues are not only torn, but also crushed;
• bruised. Inflicted by a blunt object or resulting from a fall on a blunt object;
• firearms. Such wounds are caused by firearms or shrapnel from exploding ammunition;
• scalped. This type of wound is characterized by separation of a certain area of ​​skin;
• poisoned. Wounds into which a toxic substance enters during an injury or bite.

Classification of injuries by severity

All types of damage can have varying degrees of severity:

1. Easy. As a result of such an injury, no serious disorders occur in the body and the person remains in working condition. This degree includes abrasions, scratches, minor bruises and sprains, and abrasions. Such lesions require medical attention. For minor injuries, moderate physical activity is allowed.
2. Moderate weight. Injuries of this kind lead to significant disturbances in the functioning of the body, and cannot be avoided without medical assistance. A traumatologist can give sick leave for 10-30 days. In this case, physical activity is undesirable.
3. Heavy. This type of damage leads to pronounced disturbances in the functioning of the body. A person may be unable to work for more than a month. In most cases, hospitalization of the victim is required, followed by treatment in a hospital.

Depending on the degree of impact, the following types of injuries are distinguished:

• spicy. When one or another traumatic factor influences;
• chronic. When the same traumatic factor affects the same place;
• microtraumas. When damage occurs at the cellular level.

Classification by damage location

Depending on the location of the injury, injuries are divided into the following types:

• isolated. The damage is localized in one organ or in a segment of the musculoskeletal system;
• multiple. Several injuries occur at once;
• combined or polytraumas. In such a situation, several areas of the body are damaged at once, for example, the head, chest and limbs. Often, when more than 5 zones are injured, a person may experience traumatic shock;
• combined. Such lesions can be inflicted sequentially or at one time, but by different agents, for example, chemical and thermal burns. Often such injuries have a very severe clinical picture and a high mortality rate for victims.

Classification by penetration degree

Depending on how deep the damage has penetrated into the body, it is customary to distinguish the following types of injuries:

• superficial. The damage affects only the skin and skin vessels, resulting in hematomas and abrasions;
• subcutaneous Damage affects tendons, ligaments, muscle fibers, joints and bone tissue;
• cavitary. This is the most severe type of injury from this classification, since they are characterized by damage to internal organs located in the natural cavities of the body.

Spinal injuries

The spine is one of the most important parts of our body, so its injuries are classified as a separate section. The spine can be damaged by falling from a height, during a car accident, doing strength sports, and even by improperly lifting heavy objects. Depending on the cause of spinal injury, there are:

• compression The vertebral body is compressed, cracked or broken. Such an injury can damage not one, but several vertebrae at once;
• damage caused by excessive bending and unbending of the ridge. You can get them not only in a car accident, but also if safety precautions are not followed;
• spinal bruise. This injury is dangerous due to its complications, which can arise if medical assistance is not provided in a timely manner;
• gunshot wound to the spine.

Spinal injuries are also distinguished depending on the affected area. Most often they are diagnosed in the lumbococcygeal region, most rarely in the thoracic region, there are also injuries to the cervical and coccygeal region.

Spine injuries can be open or closed, and with or without spinal cord injury.

What to do in this or that case

Depending on the type of injury, first aid and further treatment will differ, so it is important for the victim to immediately call an ambulance or take him to a doctor immediately after the injury. First aid may be as follows:

• with sprained ligaments. Limit the injured area with a bandage, apply ice over it, and place the area itself above the level of the head;
• with dislocation. The dislocated limb is fixed and ice is applied to it. It is strictly forbidden to adjust it yourself!;
• for bruises. A cold compress is sufficient; in rare cases, a fixing bandage may be needed;
• for fractures. The limb is immobilized as much as possible and ice is applied to it;
• the wounds are first washed with warm running water or hydrogen peroxide, the bleeding stops, and the edges of the wound are coated with iodine. A clean, dry bandage is applied over the top;
• in case of frostbite, you need to warm the victim with dry heat and touch the skin on the affected areas as little as possible;
• for burns, you need to cool the affected area with running cold water, give a painkiller and cover the wound surface with a clean sheet soaked in cool water;
• In case of electric shock, you must initially separate the victim from the action of the current; to do this, you can either turn off the switch or throw the person away with a wooden board or stick. Next, the victim needs to be laid down, covered with a blanket and given a warm drink.

Whatever the injury, in order to prevent the development of complications and negative consequences, you should definitely consult a doctor at the first opportunity.

Damage to the humerus

Shoulder dislocations account for up to 60% of all traumatic dislocations, and humerus fractures account for an average of 9-12% of all fractures.

Shoulder dislocation . The joint is often injured due to the small contact area of ​​the articular surfaces, since the cartilaginous surface of the head is much larger than the surface of the articular cavity and has a smaller radius of curvature. The injury occurs as a result of a fall on an outstretched, raised and abducted arm.

Symptoms: sharp pain, dysfunction, asymmetry of the shoulder joints due to the characteristic deformation of the injured shoulder - instead of rounded outlines

Treatment: a dislocated shoulder is reduced under local anesthesia or under short-term general anesthesia. After eliminating the dislocation and radiography, immobilization is carried out using a plaster splint, applying it from the healthy shoulder girdle at the back from above and continuing down the injured shoulder to the metacarpophalangeal joints.

Proximal humerus fractures.

They can be intra- and extra-articular. Intra-articular fractures include fractures of the head and anatomical neck, and extra-articular fractures include fractures of the tubercular region and surgical neck.

Fractures of the head and anatomical neck of the humerus.

Occur as a result of a fall on the elbow or a direct blow to the outer surface of the shoulder joint. They are relatively rare, mainly in older people.

Symptoms: the shoulder joint is increased in volume due to swelling and hemorrhage; active movements in the joint are limited or impossible due to pain. Radiography of the shoulder joint is of decisive importance for diagnosing the type of fracture.

Treatment: if the greater tubercle is torn off with displacement, the fragments are repositioned; the limb is fixed using an abduction splint for 1.5 -2 months. If necessary, the fragment is fixed with a knitting needle or screw. If the greater tubercle is torn off without displacement, the limb is placed on a scarf for 10 to 15 days, then movement is allowed. Working capacity is restored after 2 - 2.5 months.

Fractures of the surgical neck of the humerus. They occur quite often due to the fact that the cortical layer of this area is thinner than in other places of the humerus.

Fractures of the surgical neck without displacement of the fragments are usually impacted. Fractures with displacement of fragments, depending on their position, are divided into adduction (adduction) and abduction (abduction)

Symptoms: with abduction and adduction fractures with significant displacement, swelling and hemorrhages are observed in the area of ​​the shoulder joint, and the axis of the limb is changed. Active movements are impossible, and passive ones are sharply painful.

Treatment: for impacted fractures without angular displacement or with slight displacement (in elderly people), conservative methods are used. After anesthesia, the arm, bent at the elbow joint at an angle of 60 - 70°, is suspended on a scarf, placing a cushion in the axillary region. In case of damage to blood vessels or nerves as a result of a fracture and the impossibility of straightening the fragments in a conservative way, surgical methods are used - open reposition of fragments and osteosynthesis with the help of spokes, screws.

Fractures of the humerus in the distal region.

Intra-articular fractures include transcondylar fractures, T- and V-shaped condylar fractures, and a fracture of the head of the humeral condyle.

Symptoms: deformation of the elbow joint and lower third of the shoulder; the arm is bent at the elbow joint; movements in the elbow joint are painful. With intra-articular fractures, pathological mobility and crepitus are determined.

For displaced fractures, reduction is possible using skeletal traction on an abductor splint by the olecranon process. Reposition is controlled radiographically. If it is not possible to reduce the fragments, osteosynthesis of the condyles is used with knitting needles, screws, bolts, or V-shaped plates

Treated: for supracondylar fractures, after anesthesia, the fragments are repositioned. After this, the limb is fixed with a posterior plaster splint (from the metacarpophalangeal joints to the upper third of the shoulder) and bent at the elbow joint to an angle of 90-100°; the forearm is fixed in the middle position between supination and pronation. For displaced fractures, reduction is possible using skeletal traction on an abductor splint by the olecranon process.

A frequent type of injury is a wound - this is damage directly to the skin and mucous membranes with a violation of their anatomical integrity due to mechanical action.

Injuries have different circumstances of occurrence: they can be inflicted accidentally, received in combat, or result from a surgical operation. So, let's take a closer look at what types of wounds there are and what first aid needs to be provided.

Classification of wounds and their characteristics

Each injury has its own characteristics, but there are also common signs: internal and/or external, physical pain, gaping, that is, separation of the edges of the wound surface.

Depending on how the injury occurred and what object it was inflicted with, the injury can be: stab, cut, chopped, torn. There are also bruised, bitten, scalped or gunshot wounds.

A scratch, ulcer, erosion, rupture of organs without violating the integrity of the outer covering of the skin is not considered a wound.

First aid depends on the type of wound. Next, you will be presented with the types of wounds and their characteristics, methods of treating them, and what first aid should be provided depending on the type of damage.

– this type of wound has a small puncture size, the skin damage is insignificant, but the traumatic object very often touches the internal organs, since the depth of the wound is most often greater than its diameter.

Distinctive signs of puncture injuries:

• Smooth edges of the entrance puncture;
• Slight redness around;
• The bleeding is not severe;
• When the striking object remains in the wound, its edges are turned inward.

Puncture wounds are most often caused by an awl, nail, sharpening, pin, awl. The longer the tool, the further it penetrates directly into the tissue, the greater the risk of injury. These types of injuries occur in a criminal environment, in domestic conflicts, as well as in careless handling of sharp objects at work or at home.

– this type of injury occurs due to the action of a sharp flat object. Clear edges can be easily matched, so the wound heals faster.

The severity of the injury will depend on the force of the impact and the size of the striking object. The clinic can be different if the object touches the neurovascular bundle, large vessels and nerve fibers are damaged.

Signs of cut wounds:

• Wide clearance with different depths;
• Deep soft tissue defect;
• Heavy bleeding;
• Gaping surface;
• Unbearable pain.

The victim experiences shortness of breath, weakness, dizziness, and possible loss of consciousness. When pathological microorganisms penetrate the wound, symptoms of intoxication occur: chills, headache, nausea, fever.

– can be inflicted by a heavy object with sharp edges: an ax, a shovel, a saber, as well as machine parts in production. They are rare, but severe damage often leads to disability in patients.

Features of chopped wounds:

• Large depth and area of ​​damage;
• A massive object causes bruising and proliferation of adjacent tissues;
• Moderate wound gaping;
• Internal organs are often damaged, and physiological amputation is possible.

The chopped type of injury has a high risk of infection and purulent complications. causes a noticeable cosmetic defect, normal tissues are replaced by connective tissues.

Irreversible contractures develop in the limbs, in which it is impossible to bend and straighten in one or more joints. The functioning of internal organs is impaired.

– appear as a result of application with a blunt object: a stone, a brick, a stick, a bottle. The wound is often shallow, but high energy damage often damages internal organs. Head injuries cause brain damage, chest injuries damage the lungs and heart.

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Appearance of a bruised wound:

• Edges and fabrics are wrinkled;
• The injury follows the contours of the inflicting object;
• The wound surface is saturated with blood;
• Does not bleed or does not bleed much;
• Vessels in open areas are thrombosed.

If the blow is struck at an angle, the tissue bursts under its force, the base has a triangular shape. When the angle of application is greater than 30°, reproduction occurs evenly throughout the entire depth.

A bruised wound can be caused by a fall on a hard surface, by severe compression and stretching of tissues, or by road accidents. The bruised wound surface does not heal well, leaving a rough scar in its place.

– occur when the skin or mucous membranes are damaged by a hard, blunt object, accompanied by damage to muscles, blood vessels, and nerve fibers. The causes of injury are car accidents, accidents at home, at work, hunting or fishing.

Features of the lacerated wound surface:

• The edges are uneven with an irregular shape, crushed;
• Intense bleeding, hematomas;
• Impaired sensitivity;
• The painful syndrome is clearly expressed.

Small areas of skin may peel off; the damaged area is often contaminated with sand, glass fragments, and pieces of clothing. These injuries are often combined with fractures of the limbs, chest, spinal column, pelvic bones, and skull.

When wounded in the abdomen, the bladder, spleen, and liver often rupture.

- applied by animals or humans, their appearance resembles a torn surface, but the difference is the presence of jaw imprints. They are always accompanied by an abundant colonization of microbes from the oral cavity, often causing tetanus or rabies; their prevention is mandatory in emergency rooms.

Small bites affect only the subcutaneous layer; deep lesions damage fascia, muscles, large vessels, ligaments, and bones. Sometimes severe defects and amputations occur: fingers, hands, etc.

Treatment should be aimed directly at controlling the wound infection. Deep injuries are treated under local anesthesia, sometimes under general anesthesia. Blood clots are removed from the wound, the edges of the injury and necrotic tissue are excised. If there is a high risk of suppuration, sutures are not recommended; in some cases, drainage is installed.

– occur when safety precautions are violated as a result of limbs or hair getting into the moving blades of mechanisms, as well as during transport accidents, in everyday life due to improper or inept use of household appliances.

Scalping is characterized by extensive detachment of the skin, deeper layers and internal organs are not directly affected. This lesion is accompanied by heavy bleeding, unbearable pain, and possible pain shock. There is a high probability of developing purulent-septic consequences and pronounced cosmetic defects.

– arise as a result of firing a weapon during combat operations. The wound has a large size of damaged tissue, a severe general reaction, prolonged healing, and severe complications.

Features of gunshot wounds:

• The integrity of muscles, nerves, and blood vessels is damaged;
• There are fractures of the bones of the limbs, torso, and head;
• Hollow and parenchymal organs (lungs, liver, spleen) are damaged;
• Often end in death.

A gunshot wound can be shrapnel or bullet, depending on the nature of penetration - blind, through or tangential. A necrotic zone of dead tissue forms around the wound.

Types of wounds according to the presence and severity of the infectious process

With any injury, various pathological microorganisms enter the affected area; it is believed that all accidental injuries are infected.

According to the severity of infection, wounds are:

Other injury classifications

According to the number of injuries, wounds are: single, multiple - a wound is caused by one object several times, combined - with simultaneous injury to several anatomical areas.

Injuries of the head, neck, torso and extremities vary by location.

By type of complication: complicated and uncomplicated.

Types of wounds depending on the type of healing:

• Healing with primary intention without inflammation;
• Healing by secondary intention with suppuration and granulation;
• Healing under the scab.

Classification of wounds according to the nature of tissue damage:

• With damage to soft tissues;
• With damage to nerve fibers;
• With damage to arteries and large veins;
• With damage to bone and joint structures;
• With damage to internal organs.

According to the amount of damage, injuries are divided into:

• With a small area of ​​skin damage– the edges are barely noticeable, the area of ​​necrosis is minimal. Such wounds include stab, cut, and surgical wounds;
• With a large area of ​​damage– there is a lot of non-viable tissue, extensive hemorrhages, for example, with bruises, lacerations, gunshot injuries.

General first aid for wounds

First aid depends on the type of wound. For any type of injury, it is of great importance. First of all, it is necessary to determine its type. and the bleeding is stopped by applying a tight pressure bandage - using. Be sure to call an ambulance.

When treating a wound, the following manipulations are prohibited::

It is necessary to take anti-shock measures: apply cold to the wounded area, immobilize, and place the victim in a comfortable position for transportation.

During the provision of first aid, you need to constantly talk with the victim and maintain verbal contact with him. When the arrival of medical personnel is not expected soon, try to deliver the victim to a medical facility yourself.

Now you know, in order to provide first aid correctly and in a timely manner, you need to know the types of wounds and their signs.

3

Closed damage soft fabrics

Closed soft tissue injuries include bruises, sprains and ruptures.

Injury- mechanical damage to soft tissues or organs, not accompanied by a violation of the integrity of the skin. A bruise occurs when a blunt object strikes some part of the body (most often a limb, head) or, conversely, when falling on a hard object. The degree of damage during a bruise is determined by: the size and severity of the traumatic object; the force with which damage is caused; the type of tissue that has been bruised and its condition.

The following symptoms are characteristic of a bruise: pain, tissue swelling, hemorrhage, dysfunction.

The pain depends on the force of the blow and the location of the injury. Very severe pain occurs with bruises of the periosteum, large nerve trunks and plexuses, and reflexogenic zones.

Swelling of tissues is caused by their saturation with the liquid part of the blood (aseptic inflammation) and lymph.

Hemorrhages occur when multiple ruptures of small vessels occur. The spilled blood leads to diffuse impregnation of tissues, especially loose subcutaneous fatty tissue, which manifests itself as a blue spot (bruise) on the skin Stretching - excessive overstrain of tissues under the influence of external force in the form of traction.

As a result of external influences, the articular surfaces temporarily significantly diverge beyond the physiological norm; at the same time, the joint capsule and the ligaments and muscles that strengthen it are not damaged. Sprains of the ankle joint are often observed - for example, when the foot rolls during a fall, especially in winter. Stretching and partial tearing of ligaments and blood vessels are accompanied by swelling in the joint area resulting from hemorrhage and aseptic inflammation. Hemorrhage in the first days may be subtle and appears later in the form of dark purple spots. Movement in the joint is possible, but painful and significantly limited. Loading along the axis of the limb is painless.

For sprains, as well as for bruises, to reduce bleeding during the first 48 hours, use an ice pack; from the 3rd day - thermal procedures. At the same time, it is necessary to provide the victim with rest, an elevated position of the limb, and the application of soft pressure bandages. With proper treatment, all phenomena disappear in about 10 days.

Gap - damage to soft tissues as a result of rapid exposure to force in the form of traction exceeding anatomical fabric resistance. There are ruptures of ligaments, muscles, face tions, capsules of joints, tendons, blood vessels and nerve trunks.

Most often occur ligament ruptures: ankle, knee and wrist joints.

Often, simultaneously with a rupture of the ligamentous apparatus, damage to the joint capsule is possible. Ligament ruptures can be observed both at their attachment points and along their length. If rupture of the ligamentous apparatus is accompanied byjoint damage no capsules, then, as a rule, blood enters the joint cavity and hemarthrosis forms. This is especially true for the knee joint with damage to the intra-articular ligaments (lateral and cruciate) and menisci. In this case, sharp pain occurs, free flexion or extension in the joint becomes impossible. Due to hemorrhage into the joint and surrounding soft tissues, the contours of the joint are smoothed, and the damaged joint increases in volume. When a torn meniscus is pinched between articulating articular surfaces, a blockade of the joint occurs, which can be eliminated in a specialized medical institution.

Main featuresmuscle rupture are sudden painat the site of the rupture, the appearance of a recession visible to the eye, below itProtrusion, swelling, subcutaneous hemorrhage, and dysfunction of the limb are determined. In case of incomplete rupturemuscles, these symptoms may not be clearly expressed. FinalistDiagnosis of such damage falls within the competence of the doctor.

First aid for closed injuries denia of soft tissues. First aid is immobilization tions using soft bandages or transport splints, taking analgesics and applying cold to the injury site. The limbs are elevated to reduce soft tissue swelling.

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A wound is a violation of the integrity of the body (skin, mucous membranes) under the influence of external violence. Wounds in which only the skin and mucous membranes (up to the fascia) are damaged are called superficial. If the damage extends to deeper tissue (muscles, tendons, nerves, bones, etc.), then the wounds are considered deep. Wounds communicating with the cavity are called penetrating (wounds of the chest, abdomen, head, joint, etc.).

Depending on the nature of the wounding object, cut, stab, chopped, bruised, patchwork, scalped, crushed, bitten, gunshot and other wounds are distinguished.

It is worth highlighting a special type of superficial wounds, which very often occur in children, as well as in adults at home and at work - skin excoriation And abrasions. With the first injury, only the upper layers of the skin are damaged, with the second, all layers. The most common localization of these injuries is the fingers, hands, palm, elbow and knee joints. First aid for such injuries consists of cleaning the wound with soap, water, hydrogen peroxide, treating with any antiseptic agents (2% alcohol solution of brilliant green, chlorhexidine, poviargol), applying glue to the wound (BF-6 or MK-6), introducing antitetanus serum.

Incised wounds applied with a sharp object with little force (knife, razor, edge of glass, etc.). Surgical wounds also belong to this type. These wounds can be linear, patchy and accompanied by loss of an area of ​​cover. All of these wounds have smooth edges, and the tissue surrounding the wound is usually intact. The gaping of an incised wound is due to the elasticity of the skin and depends on the structure of the damaged tissue and the direction of the incision. Wounds located along the skin folds, such as transverse wounds on the forehead, neck and abdomen, gape less. These properties of the skin are taken into account by surgeons during operations, especially cosmetic ones, on the face, neck and other parts of the body. If the edges of the wound are in good contact, barely noticeable scars remain after healing. Incised wounds usually bleed heavily due to the fact that the vessels are completely damaged by a sharp object; their lumen gapes, since the intima (the membrane covering the inner surface of the vessel) does not wrap inward. The pain is minor and subsides quickly.

Chopped wounds The properties are similar to cut ones, but they differ in uneven, crushed edges and partial damage to adjacent tissues. Since a blow is applied simultaneously with the cut, these wounds are often deep and are often combined with damage to the bone (limbs, skull). Bleeding can be quite intense, but with significant tissue crushing, the lumen of the vessels is closed by exfoliating intima, which leads to faster blood clotting in the damaged vessels. Compression of the nerves causes more severe pain. If the cut or chopped wounds have an arcuate shape, then the tissue areas lying inside the arc can be partially separated from the underlying tissues to form a flap; such wounds are called patch wounds.

Puncture wounds occur when injured by piercing objects (awl, bayonet, nail, sharp stake, etc.). Their characteristic feature is the presence of a deep wound channel with a small external opening. The edges of the wound are compressed and damaged more when the tool is thicker or irregularly shaped (for example, a piece of a stick, a sharp piece of a metal fence, etc.). It is often difficult to judge the depth and direction of the wound channel by the appearance of the wound; however, these wounds often penetrate into the cavity of the chest or abdomen and cause injuries to internal organs or blood vessels. Since the wound channel, after removing the wounding object, has not a straight, but a tortuous shape, even with significant bleeding, blood does not come out of the wound, and in case of cavity wounds, it enters the cavity. You should always keep this in mind when providing first aid and refer such victims to a surgical facility as early as possible. The presence of a narrow tortuous course during the development of suppuration prevents the release of pus from the wound, which entails the formation of purulent streaks between the muscles and along the neurovascular bundles. The development of a purulent infection in such a wound has a very unfavorable course, so surgery should be carried out in the first hours after the injury, especially with injuries to large vessels or with penetrating wounds of the abdominal or thoracic cavity.

Damage to nerves and tendons is indicated by impaired sensation distal to the site of injury and the absence of movement in one or another part of the limb or in the entire limb. Profuse bleeding from the wound, severe pallor of the skin, and a frequent thread-like pulse indicate damage to a large vessel. Great difficulties in early diagnosis arise with puncture and penetrating wounds of the abdominal cavity. With such injuries, even a suspicion of the possibility of a penetrating injury is the basis for prompt revision of the wound in the early stages.

The favorable features of cut, chopped and stab wounds include significantly better tissue regeneration than with wounds with a large area of ​​damage, and even more so with gunshot wounds. Therefore, such wounds do not require plastic closure.

Bruised And crushed wounds occur as a result of exposure to blunt objects (fall from a height, impact with moving machine parts, falling loads, moving cars, especially in road accidents; the latter type of injury is the most unfavorable, since, along with the extent of the damage, there is additional contamination of the wounds with road dust, earth and etc., which significantly worsens the prognosis and increases treatment time). The edges of such wounds over a significant area are bruised, crushed, pale or grayish-violet in color due to impaired peripheral blood flow. As a rule, crushed tissues are insensitive due to contusion, rupture or crushing of the nerve fibers innervating these areas. All these changes lead to a sharp decrease in tissue viability, which is a favorable condition for the development of wound infection. The purulent process continues for a long time until all dead tissue is rejected.

When a force is applied in an oblique direction to the surface of the body, part of the integument often shifts along with the underlying tissues, which leads to the formation of cavities (the so-called wound pockets), which are subsequently filled with blood and lymph. Such wounds initially gape little due to the loss of tissue elasticity, but later, with necrosis of the wound edges, they can increase significantly.

Bleeding due to crushing of blood vessels is not profuse. However, with accompanying ruptures of internal organs, it can be massive and life-threatening.

Severe injuries include torn And bitten wounds. They occur when parts of the body are accidentally caught by rotating parts of machines and mechanisms, and a section of torn skin with underlying tissue can be completely separated from the body. When providing first aid, separated areas of skin must be sent along with the patients to a medical facility (especially when the skin of the scalp is torn off - with the so-called scalping of the head). These flaps, after appropriate treatment, are used to close wounds.

Bite wounds more often caused by domestic animals (dogs, cats, horses, pigs), less often by rats, snakes and, as an exception, by humans. Most often the fingers, feet, and shins are affected. These wounds are characterized by tooth marks, crushing of deep tissues, damage to nerves, tendons, and bones. When treating such wounds, a wide incision and good drainage are required. Specific treatment against rabies and tetanus should be started immediately (even in the absence of absolute indications). For snake bites, first aid should be aimed at reducing the amount of venom in the wound and slowing down the absorption of the venom into the tissue. To do this, blood and tissue fluid are suctioned from the wound, the limb is cooled, and immobilization is performed. Victims must be quickly hospitalized for specific treatment.

Gunshot wounds arise as a result of injury from shot, bullets, fragments of mines, grenades and artillery shells, ball bombs, and various types of military missiles. Gunshot wounds can vary in shape and severity, which makes their classification much more difficult. They require separate consideration.

Traumatology and orthopedics. N. V. Kornilov