Traumatic injuries to the body also have their own code in the international classification of diseases. In most cases, an incised wound of the hand according to ICD 10 will relate to one nosology, but there are exceptions, for example, superficial wounds.
Moreover, upon diagnosis it should be taken into account which structures were damaged: vessels, nerves, muscles, tendons or even bones. In the classification of open wounds of the hand, mechanical amputation is excluded.
Encoding Features
This nosology belongs to the class of traumatic injuries to the body, poisoning and some additional consequences of external influences.
According to ICD 10, a bite wound of the hand or any other open wound belongs to the wrist injury block. This is followed by a section of open wounds, which includes the following codes:
- S0 – damage without involving the nail plate;
- S1 – finger injury involving the nail;
- S7 – multiple wounds of the limb up to the level of the forearm;
- S8 – damage to other parts of the hand and wrist;
- S9 – injury to unspecified areas.
If the incised wound involves the forearm, then the coding will change, since several structures are involved in the process. The same applies to purulent complications of mechanical damage.
An infected wound of the hand, ICD 10 code S61, is a soft tissue injury caused by bacterial agents. Develops after occurrence pathogenic flora inside the defect cavity. The condition is caused by non-compliance with asepsis rules.
Modern technologies, drugs, qualified doctors help solve the problem of hand injuries without development pathological complications. The situation when a wound becomes infected is rare.
Infected wounds are designated by different ICD 10 codes depending on the location.
The healing process occurs in three stages:
- According to ICD 10, the first stage is manifested by a typical protective reaction to damage - a local increase in body temperature, swelling, pain.
- In the second phase, proliferation of new epidermis occurs. The defect is closed connective tissue. The process will not start. The reason is microorganisms that enter the cavity. Suppuration develops.
- Complete healing will occur after the complications have resolved.
Brushes
Infected wounds of the hand and other areas of the body are divided into several subtypes, which are determined by the mechanism of injury skin.
According to the international medical classification, types of wounds are distinguished:
- Cut. Appears due to the impact of a sharp object on soft fabrics brushes The healing of the defect depends on the depth of the damage. Consequences are rare.
- According to the ICD, puncture is formed under the influence of a massive object with a sharp end. It has a large width and length. With an infected lesion, microbes spread with an increase in the area of damage. A person struggles with complications of the disease for a long time.
- A bruised hand is characterized by minimal disruption of the integrity of the skin of the hand. Necrosis occurs due to poor blood supply.
- According to statistics, laceration and bite wounds in 60% of cases are complicated by infection. Bacterial agents enter the defect with the animal's saliva.
- Crushed occurs under the influence of a massive object on the tissue of the hand. There is a high probability of developing toxicosis and infection.
- Gunshot wounds are difficult to treat. The condition of infected wounds threatens the development of consequences. According to the ICD, inflammation and pus discharge are observed.
The hand area is characterized by a developed circulatory system.
The ulnar and radial arteries form many small branches that supply the dorsal and palmar surfaces with blood. If pathogenic microorganisms get inside a wound localized in the hand area, complications may arise. Septic shock during infection develops when bacteria penetrate into the vascular bed.
Finger
An infected finger wound, code according to ICD 10 S61.1, is a lesion of the skin with penetration of bacteria. Occurs when careless use of cutting and piercing instruments in everyday life. Infection of a finger can occur in two ways. In the first case, the pathogens pathological process fall on the damaged epidermis at the time of injury. In the second - when there is a violation of the processing of the defect of the hand and finger.
Healing on the finger depends on the depth of the injury, the degree of infection, and the presence of injured muscles, tendons, and joints. Proper care, timely request for medical care help prevent the development of sepsis and abscess. Recovery occurs within 2-3 weeks.
Forearms
An infected wound of the forearm, code according to ICD 10 S51.9, is open and superficial. In the first case, the insides of the defect are in contact with external environment. Multiple injuries pose a danger. They can occupy large areas of the forearm. Superficial is formed due to a bruise. There is a high risk of infection with an open wound, where microbes can freely penetrate a few minutes after traumatizing the skin and spread through the bloodstream into the hand.
Main features purulent inflammation An infected epidermal defect is marked redness of the edges of the damaged area, high body temperature, discharge yellow color. On palpation, the pathological area is painful, and the main functions of the injured forearm are disrupted.
Elbow joint
Infected wound elbow joint occurs when a fall on the hand, a strong blow, or divergence of the seams after surgical intervention. Pathogenic microflora infects cavity tissue after improper treatment.
The elbow joint is responsible for the flexor and extensor muscles. The development of a purulent infected process can result in loss of function due to the rapid spread of infection. Bacteria penetrate into the forearm and hand through anatomical channels and blood.
According to ICD 10 main symptoms infected wound: suppuration, bad smell, swelling, red edges of the damaged surface, high temperature. Without timely treatment the situation ends with the development of phlegmon or abscess.
How to treat an infected wound
The pathology is treated in a surgical hospital when the condition is severe. Infected hand wounds require integrated approach to therapy. A course is required that includes antibacterial agents, antiseptics.
The use of antibiotics orally or by injection is indicated for high temperature body, which lasts more than 3 days. According to ICD 10, medications suppress the proliferation of microorganisms within an infected pathology and spread throughout the body. Antimicrobial drugs are semisynthetic penicillins, which have wide range actions. If penicillins are ineffective, they resort to cephalosporins and macrolides.
According to ICD 10, the area of the infected wound requires surgical treatment.
According to ICD 10, the purpose of the procedure is to cleanse the cavity of the hand or other part of the body from contents - necrotic tissue, bacterial agents. The surgical surface is first disinfected with antiseptic drugs. Then they cover it with sterile napkins, numb it, install a drainage, and secure the structure with bandages. Manipulation helps get rid of pus.
According to indications, antibacterial ointments are prescribed to enhance the effect in the fight against pathogenic microorganisms and infection. Use Erythromycin, Streptomycin. To strengthen protective functions The body uses immunostimulants.
Possible complications and prognosis for recovery
The prognosis of an infected hand wound depends on the depth, degree of infection, localization, and spread to underlying tissues. Under the influence intensive care more happens fast recovery patient. According to ICD 10, recovery period takes from 2 to 4 weeks.
Advanced cases of infected pathology require long-term treatment. Main complications of the condition according to ICD 10:
- Phlegmon of the hand is a purulent melting of tissue.
- An abscess is a localized area of pus surrounded by a capsule.
- Gas gangrene develops when it penetrates into the affected area of the hand anaerobic microorganisms which do not require oxygen to reproduce. Symptom: crepitus when pressing on an infected wound.
- Septic shock according to ICD 10 is characterized by systemic inflammatory reaction weakened body. Caused by the penetration of pathogenic microorganisms into the bloodstream. The situation requires immediate treatment in the intensive care unit.
RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2007 (Order No. 764)
Open wounds involving multiple areas of the body (T01)
general information
Short description
Wound- damage to body tissues due to mechanical impact, accompanied by a violation of the integrity of the skin and mucous membranes.
Protocol code: H-S-026 "Wounds various localizations"
Profile: surgical
Stage: hospital
ICD-10 code(s):
T01 Open wounds involving multiple areas of the body
S21 Open wound chest
S31 Open wound of the abdomen, lower back and pelvis
S41 Open wound shoulder girdle and shoulder
S51 Open wound of the forearm
S61 Open wound of wrist and hand
S71 Open wound area hip joint and hips
S81 Open wound of the leg
S91 Open wound of the ankle and foot area
S16 Injury to muscles and tendons at the neck level
S19 Other and unspecified neck injuries
S19.7 Multiple neck injuries
S19.8 Other specified neck injuries
S19.9 Neck injury, unspecified
T01.0 Open wounds of the head and neck
T01.1 Open wounds of the chest, abdomen, lower back and pelvis
T01.2 Open wounds of several areas of the upper limb(s)
T01.3 Open wounds of several areas of the lower limb(s)
T01.6 Open wounds of several areas of the upper and lower extremities
T01.8 Other combinations of open wounds involving multiple areas of the body
T01.9 Multiple open wounds, unspecified
Classification
1. Stabbed - as a result of exposure to a sharp object.
2. Cut - as a result of exposure to a sharp long object, no less than 0.5 cm in size.
3. Bruised - as a result of exposure to an object of large mass or high speed.
4. Bitten - as a result of the bite of an animal, less often a person.
5. Scalped - skin peels off and subcutaneous tissue from the underlying tissues.
6. Firearms - as a result of the action of a firearm.
Diagnostics
Diagnostic criteria:
Pain syndrome in the injured limb;
Forced position of the injured limb;
Limited or absent limb mobility;
Changes in soft tissue over the fracture site (swelling, hematoma, deformation, etc.);
Crepitation upon palpation of the suspected injured area of the leg;
Related neurological symptoms(lack of sensitivity, coldness, etc.);
Damage to the skin according to the above classification;
X-ray signs of injury to underlying tissues.
List of main diagnostic measures:
1. Determination of the type of injury in accordance with the given classification.
2. Determination of the degree of dysfunction of the injured organ (range of motion).
3. Clinical examination of the patient (see diagnostic criteria).
4. X-ray examination injured lower leg in 2 projections.
5. General analysis blood.
6. General urine analysis.
7. Coagulogram.
8. Biochemistry.
9. HIV, HbsAg, Anti-HCV.
List of additional diagnostic measures:
1. Determination of blood group and Rh factor.
2. Determination of sensitivity to antibiotics.
3. Determination of blood sugar.
Treatment
Treatment tactics
Treatment goals: timely diagnosis wounds taking into account their location, definition therapeutic tactics(conservative, surgical), prevention possible complications.
Treatment: the need for anesthesia depends on the type of wound according to the classification. Taking into account the violation of the integrity of the skin, it is necessary to administer tetanus toxoid.
Conservative treatment:
1. Primary surgical treatment of the wound.
2. If the wound is not infected, antibiotic prophylaxis is not carried out.
1. Application of primary sutures in the absence of signs of wound infection.
2. Antibiotic prophylaxis is carried out for 3-5 days for wounds received more than 8 hours ago with high risk infections:
Moderate and severe wounds;
Wounds reaching a bone or joint;
Hand wounds;
Immunodeficiency state;
Wounds of the external genitalia;
Bite wounds.
3. Surgical treatment of wounds is indicated when damage to a nerve or vascular bundle is confirmed.
The results of multicenter studies have established that the use of antibiotic prophylaxis in patients with wounds reduces the risk of developing purulent-inflammatory complications.
Patients can be divided into 3 risk groups:
1. Injuries with damage to the skin and soft tissue less than 1 cm in length, the wound is clean.
2. Injuries with skin damage more than 1 cm in length in the absence of significant damage to the underlying tissues or significant displacements.
3. Any injuries with severe damage to underlying tissues or traumatic amputation.
Patients of risk groups 1-2 require a dose of antibiotics (as early as possible after injury), mainly with an effect on gram-positive microorganisms. For patients at risk group 3, antibiotics that act on gram-negative microorganisms are additionally prescribed.
Antibiotic prophylaxis regimens:
For patients of risk groups 1-2 - amoxicillin 500 thousand after 6 hours, 5-10 days per os;
Patients of the 3rd risk group - amoxicillin 500 thousand after 6 hours, 5-10 days per os + clavulanic acid 1 tablet 2 times.
List of essential medications:
1. *Amoxicillin tablet 500 mg, 1000 mg; capsule 250 mg, 500 mg
2. *Amoxicillin + clavulanic acid film-coated tablets 500 mg/125 mg, 875 mg/125 mg, powder for solution for intravenous administration in bottles 500 mg/100 mg, 1000 mg/200 mg
3. *Cefuroxime powder for solution for injection in a bottle 750 mg, 1.5 g
4. Ceftazidime - powder for the preparation of solution for injection in a bottle of 500 mg, 1 g, 2 g
5. Ticarcillin + clavulanic acid, lyophilized powder 3000 mg/200 mg for solution for intravenous infusion
6. *Nitrofural 20 mg tablet.
List of additional medications: no.
Indicators of treatment effectiveness: wound healing, restoration of functions of damaged organs.
* - drugs included in the list of essential (vital) medicines.
Hospitalization
Indications for hospitalization: emergency.
Information
Sources and literature
- Protocols for diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 764 of December 28, 2007)
- 1. Evidence-based medicine. CLINICAL GUIDELINES for practicing doctors. - Moscow, Geotar-Med. - 2002. - p.523-524 2. Surgery. Guide for doctors and students. - Moscow, Geotar-Med. - 2002. - pp. 576-577 3. National Guideline Clearinghouse. Practice Managment for Prophylactic Antibiotic Use in Open Fracture: Eastern Association for the Surgery of Trauma.- 2000.- p.28 4. National Guideline Clearinghouse. Preoperative Test: the Use of Routine Preoperative Tests for Elective Surgery: Evidence, Methods&Guidance. London.-NICE.- 2003. 108p.
Information
List of developers: Ermanov E.Zh. Scientific Center of Surgery of the Ministry of Health of the Republic of Kazakhstan
Attached files
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Clinical manifestations and treatment tactics for damage to the tendons of the hand depend on the location of the wound, its contamination and the degree of damage to the soft tissues. With a clean, smooth (usually cut) wound and good nutrition soft tissues of the hand (in the absence of concomitant damage to the arteries), a primary tendon suture is performed.
The earlier the operation is performed, the higher the chances of good wound healing and restoration of tendon function. The optimal time for surgery is within the first 6 hours after injury. The deadline during which the primary suture of the tendon is possible is 24 hours from the moment of injury.
In traumatology, restoring finger function when the hand tendons are damaged is difficult. surgical intervention, which often requires the use of microsurgical techniques. The operation is performed under a tourniquet, with minimal tissue trauma, under local or regional anesthesia (so that the patient can bend his fingers on command while checking tendon repair). IN postoperative period the hand must be fixed plaster cast.
In case of extensive damage to soft tissues (lacerations, crushing), significant contamination of the wound and late application If the tendons of the hand are damaged, a delayed secondary suture of the tendon is performed to a traumatologist. The operation is carried out as soon as possible early dates after complete healing of the wound.
Isolated injury to the deep flexor tendon. Occurs only when the area is injured nail phalanx. The patient cannot bend the joint located between the nail and middle phalanges. If during the operation it is possible to locate the proximal end of the deep flexor muscle, the tendon is sutured. In cases where the proximal end cannot be found, the peripheral end of the flexor muscle is sutured to the bone. middle phalanx.
Isolated injury to the superficial flexor tendon. Possible with injuries to the fingers (with the exception of the nail phalanx), damage to the palmar surface of the hand at any level and injury to the lower third of the forearm. The patient cannot bend the joint located between the middle and main phalanges. During the operation, the proximal end of the tendon is found. If necessary, an additional incision is made in the palm, through which the central end of the tendon is brought out into the peripheral wound using a guide.
If the ends of the tendon are crushed or disintegrated, they are excised. In order to prevent postoperative flexion contracture, operations are performed to lengthen the tendon in the tendon-muscular part or to extend it in a Z-shape proximal to the area of damage.
With wounds in the area of the middle and main phalanges of the fingers, and, especially often, with a wound in the palm area, simultaneous damage to the deep and superficial flexors is observed.
Damage to both flexor tendons. No proximal or distal flexion interphalangeal joint. Only the deep flexor tendons are repaired. The ends of the superficial flexor tendons are excised.
In case of injuries to the lower third of the forearm, damage to the flexor tendons is often combined with a violation of the integrity of the veins, ulnar and median nerves, ulnar and radial artery, tendons of the radial and ulnar flexors of the hand.
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Read more >>>S80-S89 Knee and lower leg injuries
Excludes: superficial trauma hip area(S70.-)
Excludes: open wound of the hip joint area (S71.0) traumatic amputation of part of the abdomen, lower back and pelvis (S38.2 -S38.3)
Included: fracture at the level of the lumbosacral spine. vertebral arches.
spinous process. transverse process.
Excludes: dislocation, sprain and strain of the hip joint and ligaments (S73.-) obstetric trauma of the joints and ligaments of the pelvis (O71.6) ruptures or displacement (non-traumatic) intervertebral disc V lumbar region(M51.-)
The following subcategories are given for optional use in additional characterization of the condition when it is impossible or inappropriate to carry out multiple coding: 0 - without an open wound in abdominal cavity 1 - with an open wound in the abdominal cavity
The following subcategories are provided for optional use in additional characterization of a condition where multiple coding is impossible or inappropriate: 0 - without an open wound in the abdominal cavity 1 - with an open wound in the abdominal cavity Excludes: trauma to the peritoneum and retroperitoneal space (S36.8)
In cases closed injury Heart bruise accounts for up to seventy percent. A heart exposed to a shock, depending on how severe the damage has occurred, can cope with the consequences on its own or will require the help of doctors. In any case, it is necessary to consult a specialist so as not to waste time if the diagnosis shows the need to undergo treatment.
Internal organs fairly well protected from mechanical damage. However, injuries are possible here too. Kidney bruise is not the most common occurrence and is usually associated with damage to other pelvic organs.
S80 Superficial injury of the leg
S81 Open wound of the leg
S82 Fracture of lower leg bones, including ankle joint
S00 Superficial head injury
S01 Open head wound
S02 Fracture of the skull and facial bones
S03 Dislocation, sprain and strain of joints and ligaments of the head
S04 Cranial nerve injury
S05 Injury to the eye and orbit
