A wound is damage to the skin, and often also to other, deeper tissues. There are many types of wounds, including cut wounds, stab wounds or bruised wounds, as well as thermal, chemical and gunshot wounds. This is not the only division of wounds. When are wounds sewn? What are the most common complications in wound healing?

Woundis a break in the anatomical continuity of a tissue or organ due to the action of a penetrating or non-penetrating damaging factor. Damaging factors include physical, chemical, thermal and ionizing radiation.

Wounds - types

Due to the depth of tissue damage, the following are distinguished:

  • abrasions and scratches: the epidermis and the superficial layer of the dermis are damaged
  • wounds:

a)superficial wounds : do not cross the subcutaneous fat layer b)deep wounds : cross the subcutaneous fat layer c) penetrating wounds : penetrate deeply located organs or body cavities

Wounds can be divided into simple and complex. Simple wounds are superficial wounds and usually concern the integuments of the body. In the case of compound wounds, the vessels, nerves, tendons and internal organs are damaged.

Due to the mechanism of tissue damage, the following traumatic wounds are distinguished:

  • cut wounds- these are wounds inflicted with a pointed object. They are characterized by even and smooth edges, a slit-like shape and usually profuse bleeding. Heal well
  • stab wounds- arise as a result of the action of pointed tools. Within them, there is a puncture hole, a channel and a puncture hole (as long as the tool will pierce the body right through). Sometimes deeper tissues and organs are damaged
  • bruising wounds- are the result of hitting with a blunt tool or hitting a hard object or substrate. They have uneven edges and bleed moderately. The surrounding tissues are bruised and swollen. Often there are injuries to internal organs and bone fractures
  • chop wounds- they are inflicted with a high cutting force and are usually deep. They combine the features of cut and bruised wounds

One type of wound is bedsores. It damages the skin as wellthe underlying tissues and bones that appear when lying down for a long time. They arise due to prolonged pressure that inhibits the proper blood flow.

  • crushed wounds- they arise similarly to bruised wounds, but the force acting on the tissues is greater, and thus the tissue injuries are more serious. This results in extensive tissue damage and frequent bone fractures. Moreover, there is little or no bleeding from such wounds
  • lacerations- arise as a result of an object with sharp and uneven edges on the tissue (e.g. circular saw, barbed wire), which attacks with great force obliquely or tangentially to the body surface . These wounds have jagged, uneven, and often ischemic edges. Sometimes the covering tissues may be torn and detached or completely detached from the substrate, resulting in a tissue loss
  • flap wounds- inflicted with an object operating obliquely to the body surface, which results in tissue detachment
  • bitten wounds- these are badly healing wounds caused by bites, which - depending on the type of dentition - may have the character of a lacerated, stab or crushed wound
  • gunshot wounds- are the result of being injured by a firearm bullet, bomb fragments or mines. These wounds have an inlet and often an outlet connected by a channel. The entrance wound is usually small, while the exit wound is much larger, with jagged edges and skin defect. It is worth knowing that a wound without an outlet is the so-called blind wound
  • amputation wounds- arise as a result of the complete separation of peripheral parts of the body (e.g. limbs, nose, ears)
  • poisoned wounds- most often the result of bites by insects, arthropods or reptiles. There is swelling, redness and soreness in the wound area, and sometimes a bite mark is visible
  • thermal wounds- the result of burns with boiling water, hot liquids, steam, flame, etc.
  • chemical wounds- caused by burns with lyes and acids

Due to the cleanliness of the operating field, wounds are also divided into clean, clean-contaminated, contaminated and dirty.

  • clean woundsare surgical wounds in which there is no contact with inflammatory lesions or the opening of the digestive, respiratory, urinary or sexual systems. They are closed with primary sutures and drained in a closed system (if necessary)
  • clean-contaminated woundsare surgical wounds open to the digestive, respiratory, urinary orbut to a controlled extent, without excessive contamination of the operating field
  • contaminated woundsare open, fresh, accident wounds. They occur during the operation without observing the rules of sterility, e.g. open heart massage or with significant leakage of contents from the gastrointestinal tract, and in the case of contact with sharp non-inflammatory changes
  • dirty woundsare old traumatic wounds with the presence of dead tissue fragments and wounds in which there is a contact with an infected area or perforation of the viscera. It is important that the microorganism causing the infection was present in the surgical field even before the operation

Wound healing

Wound healing takes place in 4 phases, which include the inflammatory phase, the productive phase, wound contraction and wound remodeling.

  • inflammatory phase

In the inflammatory phase, there is an increase in blood flow and tissue oxygen partial pressure, extravasation of granulocytes, macrophage precursors, platelets and platelet factors, and plasma antibodies. In addition, tissue macrophages are activated and chemokines and cytokines are produced.

  • development phase

The essence of the production phase is the production of connective tissue - collagen and compounds of the basic substance. Iron ions, zinc, copper, vitamins A and C and amino acids are essential for this process.

  • shrinking the wound

Wound contraction is more precisely about shrinking fibroblasts by blocking their position by the deposited and maturing collagen and glycosaminoglycans.

  • wound remodeling

The final stage of wound healing is the formation of collagen cross-links. Excess collagen is degraded, the content of glycosaminoglycans, cell infiltrates and the density of the capillary network are reduced. It is worth knowing that this phase lasts from 3 weeks to many years.

Wounds can heal through early growth or granulation. Healing by rapid growth is primary healing - it concerns clean, properly sutured wounds and lasts up to 6-8 days. On the other hand, wound healing by granulation is secondary healing - it concerns unsealed, often infected wounds. Its essence is the production of granulation tissue at the bottom of the wound and the growth of the epidermis from the edges.

Wound - complications related to the wound

The current progress in the field of surgical wound healing has been achieved thanks to the use of modern methods of aseptic and antiseptic treatment, adequate hemostasis, and improvement of surgical techniques and the quality of surgical sutures. Even so, there are still situations where it occursdisorders of the healing process. It depends on the type of surgery, underlying disease, comorbidities, supply technique and the surgeon's experience.

The most common wound complications include:

  • bleeding from a wound
  • hematoma in the wound
  • wound dehiscence followed by postoperative hernia formation
  • wipe
  • wound infection (sometimes with abscess formation)
  • Chronic wound or keloid wound formation

It is important to know that there are many local and systemic factors that adversely affect the wound healing process. These types of local factors include, but are not limited to:

  • mistakes in suturing the wound (placing sutures too far from the edges of the wound, using too thick threads, tying the threads too tight)
  • inaccurate hemostasis with formation of a hematoma in the wound
  • local infections

Systemic causes include:

  • old age
  • infection
  • diabetes
  • severe malnutrition
  • uremia
  • jaundice
  • advanced neoplastic disease with cachexia

Proper supply of oxygen and nutrients, correction of hypovolemia, pain relief and prevention of hypothermia are extremely important in the wound healing process.

Wound - sewing wounds

Wounds are sewn with surgical sutures, tweezers and a vice - an instrument used to hold the needle of the surgical suture during suturing. Needles are divided into prickly needles (they have a circular cross-section) and cutting needles (they have a triangular cross-section). Modern suture materials are divided into absorbable and non-absorbable, and natural and synthetic.

Interestingly, most of the currently used sutures are atraumatic sutures, which have the thread embedded in the needle - such a seam creates a channel in the tissues the width of the needle itself. Absorbable materials gradually break down in tissues and at the same time lose their strength much faster. They are divided into materials with short, medium and long-term ability to maintain their tension in tissues. Among the non-absorbable materials, there are natural materials made of silk or linen, and synthetic materials - multi-fiber and monofilament.

When treating wounds, non-absorbable sutures are used for suturing the skin, and sutures that are resorbable in tissues are used for plunging sutures or for suturing mucous membranes. Sometimes non-absorbable threads are used to bring deeper tissues closer together.

Surgical sutures (threads)

There are many variationssurgical sutures. Some are more commonly used, others in special situations. There are generally two main types of seams - single and continuous.

  • Single (knotted) stitches- a knot is tied after each needle puncture (or two consecutive passes), and the excess thread is cut - each of these seams constitutes a separate entity. The placement of these sutures is time-consuming, but in the presence of complications in wound healing (e.g. suppuration, hematoma), removal of one of them does not result in serious consequences. The most commonly used single seams include, among others Plain knotted seam, plunged knuckle seam, horizontal mattress and vertical mattress seam
  • Continuous sutures- one thread segment is used to close the entire wound or a significant part of it through multiple punctures and punctures, and knots are tied only after the first and last puncture. This variety of sutures is put on much faster, shows some haemostatic effect and evenly distributes the tension of the tissues along the entire length. Unfortunately, cutting or tearing them at any point causes the edges of the wound to open completely. The most commonly used continuous seams include, among others "swivel" seam, horizontal and vertical mattress seam, "hemming" seam or intradermal suture.

It is worth remembering that each suturing of a wound must be preceded by the control of bleeding from the damaged vessels. Bleeding from small vessels is often self-limiting - sometimes you just need to press the bleeding spot with a gauze pad and wait a while for hemostasis to activate. If bleeding continues, the vessels should be ligated, punctured or possibly coagulated.

The period of keeping skin sutures depends on the area of ​​the body subjected to the procedure, the degree of tissue tension, the type of surgery performed and the quality of wound healing. Usually it is from 5 to 7 days - after this time the sutures are removed. For this purpose, the end of the seam is lifted a little with tweezers, and after the part of the thread previously in the skin appears under the knot, it is cut with scissors and the seam is removed by pulling.

Continuous sutures are usually removed in sections, while the intradermal suture is removed in such a way that after cutting the thread at its beginning, it is gently pulled along the wound axis by its end loop.

Healing without pain possible thanks to Polish scientists

We all know this unpleasant feeling of changing a dressing. Often we have to break already healed tissues. However, a new era in wound care has arrived - the biopolymer. As experts emphasize, biopolymer is otherwise "he althy skin". It is obtained from a natural source of the shells of crustaceans.

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