Uncomplicated wounds of the hand. Signs of a puncture wound and first aid Muscles and organs

Did you know that puncture wounds account for 5 percent of the reasons children are admitted to centers? emergency assistance? Such skin injuries are typically caused by sharp, narrow objects such as a nail, splinter, splinter, or similar object that penetrates the skin. These types of wounds are usually quite narrow and can be deep if the object enters the skin with significant force. Read on to find out what you should do when dealing with such injuries.

Immediate treatment. Whenever you quickly treat a puncture skin tear, the situation usually does not get worse. However, if you do not take it seriously, the infection can get through the puncture into the wound, which can become a threat to the life of the victim.
Reassure the patient. This is especially important for children and people who cannot tolerate pain. Help them remain calm until the injured area heals.
Pull out the object(only small objects - no more than 1 cm deep and 1 cm wide, otherwise this should be done by a doctor). Make sure that there are no foreign objects or parts left at the wound site. If you are unable to remove the foreign object completely, it is very likely that it could cause an infection. Do not remove the object if the wound is bleeding heavily. Maybe this item will help stop the bleeding of damaged vessels. If the pulled object results in severe bleeding, minimize the victim's movement until the victim arrives. medical care. If the cut is large, the doctor will sew it up with one of the suture materials of his choice. When using an absorbable thread, after a certain time one can hope to restore the “photogenicity” of the damaged area of the patient’s body.
Let the wound bleed for a few minutes- this will help remove all foreign substances from the wound. Puncture wounds usually do not bleed. If there is bleeding, let it continue for about two minutes, which will help clean the wound.
Stop the flow of blood. Use direct pressure on the wound - do this manually using clean gauze. The bleeding should stop within a few minutes.
Clean the wound. Use salt and warm water to wash the wound area. Make sure that no other objects enter the subcutaneous tissue during cleaning. Dirt or other objects may remain on the skin if they cannot be removed. In this case, you need medical help.
Use bandages for the necessary protection. Puncture wounds are usually not very large and do not tend to bleed, however, if they are located on the legs or other areas that get dirty easily, they should be covered with a bandage to prevent contamination.
You need to go to the doctor if you have the following symptoms that indicate you need medical attention:
- Edema
- Red skin around the injured area
- Remains of an object in the wound.

As long as the wound doesn't smell bad, there's no reason to worry.

Get a tetanus shot if needed. You need a tetanus shot if:

If your last tetanus shot was more than 10 years ago.
If the object that caused the injury was dirty or rusty and last vaccination I was diagnosed with tetanus more than five years ago.
If the victim does not know when the last tetanus vaccination was.
If the patient has never received a tetanus vaccine.

Minor puncture wounds are usually not serious and do not require a visit to the doctor.
Watch for signs of infection around the pierced area of skin while it heals. Symptoms such as redness, swelling, throbbing pain, red streaks, or pus may indicate an infection.

Pathogenesis of puncture wounds

Features of damage depend on location puncture wound. It should be noted that such injuries must be treated with particular vigilance, not excluding severe injuries based on the small size of the entrance hole and satisfactory condition sick. For wounds caused by sharpening, the depth of the wound channel can be 15-20 cm with the size of the entrance hole only 1-2 cm. Wounds caused by an awl reach 8-10 cm in depth, and the length of the channel left by a metal pin is completely impossible to predict without carrying out PHO.

Injuries in the area of the neurovascular bundles may be accompanied by damage to blood vessels and nerves. At the same time, the absence of massive external bleeding does not exclude damage to blood vessels, since after removing a sharp object, the tissues are sometimes displaced, blocking the narrow wound channel, and the blood does not pour out, but into the natural cavities or surrounding tissues.

The likelihood of damage to internal organs depends on the location. With a wound in the chest area, damage to the lungs and heart is possible, in the abdomen - damage to the liver, spleen, intestines, in the neck - damage to the trachea, larynx and esophagus, lumbar region– damage to the kidney, etc. It should be taken into account that the possibility of injury to one or another internal organ depends not only on the anatomical zone, but also on the direction and depth of the wound channel. Thus, with a puncture wound to the abdomen, inflicted from the bottom up, damage may occur not only to the liver, spleen or stomach, but also to the chest organs. And with a similar location of the inlet, but the wound channel directed from front to back, damage to the kidney is possible.

One more distinctive feature Such wounds have an increased likelihood of developing wound infection. This feature is due to the fact that bacteria and contaminants that have penetrated into the wound cavity are poorly washed out by the blood and remain in the tissues. In addition, blood flowing not outward, but into the surrounding tissues, creates a favorable environment for the proliferation of microbes.

Symptoms of puncture wounds

With fresh puncture wounds, a small round wound hole with smooth edges is revealed on the skin. If a traumatic object (for example, a pin) remains in the wound, its edges are bent inward. Bleeding is usually minor. With stab wounds, the opening is slit-shaped or angular, the edges are smooth, one or both ends of the wound are sharp. Bleeding is usually not intense, but more blood is shed than with puncture wounds.

Other clinical manifestations depend on the location of the wounds, the presence or absence of damage to internal organs, nerves and blood vessels. A rapid increase in the volume of the damaged anatomical area in combination with weakness, dizziness and fainting indicates bleeding into the surrounding tissues; increasing shortness of breath with injury in the chest area indicates lung damage, pneumothorax or hemothorax; weakness, shock and percussion dullness of sound with injuries to the abdominal area – about possible damage to parenchymal organs (liver, spleen).

The edges of the infected wound are hyperemic, local hyperthermia is detected. Serous or purulent discharge is visible in the wound canal. Due to the development of deep-seated infection and poor drainage of contents, significant swelling of the surrounding soft tissue is often observed. Patients complain of intense tugging or throbbing pain. Symptoms of general intoxication are observed: fever, chills, weakness, weakness, headaches.

Diagnosis and first aid for puncture wounds

The diagnosis is established on the basis of anamnesis and the results of an external examination. Volume additional research depends on the condition and complaints of the patient, the location of the wound, the intended direction and depth of the wound canal. To assess blood loss, do general analysis blood. If lung damage is suspected, a chest x-ray and consultation with a thoracic surgeon are indicated; if organ damage is suspected abdominal cavity– consultation with an abdominal surgeon and laparoscopy (if there are sufficient reasons). Suspicion of damage large vessel is the basis for consultation with a vascular surgeon, suspicion of nerve damage - for consultation with a neurosurgeon.

In case of mild bleeding, the skin around the wound should be washed and disinfected, and then a sterile bandage should be applied. In case of massive bleeding, it is necessary to use one of the methods to temporarily stop the bleeding (apply a tourniquet or a pressure bandage, perform wound tamponade). If a sharp object (pin, sharpening) remains in the wound, it should not be removed, as this may lead to increased bleeding and the development of shock. All patients with puncture wounds are subject to immediate evacuation to a specialized medical institution.

Treatment of puncture wounds

Traumatologists treat fresh puncture wounds without damaging internal organs. Patients with suspected damage to internal organs, nerves and blood vessels are referred to the appropriate specialists: thoracic surgeons, abdominal surgeons, cardiac surgeons, urologists, vascular surgeons, neurosurgeons, etc. Treatment of infected puncture wounds is carried out by surgeons.

In the presence of a fresh, uncomplicated puncture wound, PSO is indicated, which is usually performed under local anesthesia. The doctor rinses with solutions of peroxide and furatsilin, examines the wound canal with a finger or probe,, if possible, excises contaminated areas and sutures the tissue layer-by-layer. To improve outflow, puncture wounds must be drained with half-tubes or rubber outlets. Drains are removed 1-3 days after surgery, sutures are removed on days 8-10. Patients with deep wounds, muscle damage and significant blood loss are subject to hospitalization in the trauma department. For minor soft tissue injuries, it is possible outpatient treatment at the emergency room. IN postoperative period UHF and antibiotic therapy are prescribed.

Damage to an internal organ is an indication for appropriate abdominal surgery. If the lung is injured, a thoracotomy is performed, if the abdominal organs are damaged, a laparotomy is performed, etc. The doctor carries out an inspection, sutures the damaged organ and performs other therapeutic measures(list of activities and tactics surgical treatment depends on the characteristics of the wound). All patients with internal organ damage are hospitalized.

Infected wounds are opened, washed and drained. Local treatment carried out against the background of antibiotic therapy. First, broad-spectrum antibiotics are used, then the drug is prescribed taking into account the sensitivity of the detected microorganisms. Depending on the patient’s condition, treatment can be either inpatient or outpatient.

Prognosis for puncture wounds

The prognosis for uncomplicated stab and stab wounds is more favorable than for lacerated and lacerated wounds. Relatively clean and smooth edges provide best conditions for healing. At the same time, the risk of developing infection with such wounds is higher than with shallow incised wounds. The prognosis for complicated wounds depends on the characteristics of the injury (the severity of damage to certain organs, the amount of blood loss, the presence or absence of shock).

– this is tissue damage in which the depth of the wound channel exceeds the width of the entrance hole. It has smooth edges and is applied with a thin sharp object (an awl, a sharpener). Massive external bleeding from puncture wounds is usually absent; the condition in the initial stages often remains satisfactory, which can lead to an underestimation of the severity of the injury. The diagnosis is made on the basis of anamnesis and external examination data. If damage to internal organs is suspected, additional studies are required: chest x-ray, laparoscopy, etc. Surgical treatment: PSO, suturing, dressings.

ICD-10

S41 S51 S71 S81

General information

A puncture wound is a wound with smooth edges, a small entrance hole and a deep wound channel. Puncture wounds in their pure form are rare. In traumatological practice, combined injuries are more often observed - stab wounds inflicted with a knife or dagger. The wound can penetrate into the natural cavities of the body (abdominal, thoracic, joint cavity), accompanied by damage to nerves, blood vessels and internal organs. Sometimes combined with TBI, bone fractures, closed chest injury, blunt abdominal trauma and injuries to the genitourinary system.

Reasons

Possible causes of a puncture wound can be a criminal incident (strike with a sharpener), an accident (falling on a pin), a traffic accident, or an industrial or natural disaster.

Pathogenesis

The characteristics of the damage depend on the location of the puncture wound. It should be noted that such injuries must be treated with particular vigilance, not excluding severe injuries based on the small size of the entrance hole and the satisfactory condition of the patient. For wounds caused by sharpening, the depth of the wound channel can be 15-20 cm with the size of the entrance hole only 1-2 cm. Wounds caused by an awl reach 8-10 cm in depth, and the length of the channel left by a metal pin is completely impossible to predict without carrying out PHO.

The likelihood of damage to internal organs depends on the location. With a wound in the chest area, damage to the lungs and heart is possible, in the abdomen - damage to the liver, spleen, intestines, in the neck - damage to the trachea, larynx and esophagus, in the lumbar region - damage to the kidney, etc. It should be borne in mind that the possibility injury to a particular internal organ depends not only on the anatomical zone, but also on the direction and depth of the wound channel. Thus, with a puncture wound to the abdomen, inflicted from the bottom up, damage may occur not only to the liver, spleen or stomach, but also to the chest organs. And with a similar location of the inlet, but the wound channel directed from front to back, damage to the kidney is possible.

Another distinctive feature of such wounds is the increased likelihood of developing wound infection. This feature is due to the fact that bacteria and contaminants that have penetrated into the wound cavity are poorly washed out by the blood and remain in the tissues. In addition, blood flowing not outward, but into the surrounding tissues, creates a favorable environment for the proliferation of microbes.

Classification

Taking into account the depth of penetration in traumatology and orthopedics, all wounds are divided into through and blind. Taking into account the features that have a significant impact on the prognosis and treatment tactics, wounds without damage and those with damage to internal organs are distinguished. Taking into account the presence of local complications, wounds complicated by massive bleeding or partial prolapse of internal organs are distinguished.

Symptoms of a puncture wound

With fresh wounds on the skin, a small wound hole of a round shape with smooth edges is revealed. If a traumatic object (for example, a pin) remains in the wound, its edges are bent inward. Bleeding is usually minor. With stab wounds, the opening is slit-shaped or angular, the edges are smooth, one or both ends of the wound are sharp. Bleeding is usually not intense, but more blood is shed than with puncture wounds.

Diagnostics

The diagnosis of a puncture wound is made based on the medical history and the results of an external examination. The scope of additional research depends on the patient’s condition and complaints, the location of the wound, the intended direction and depth of the wound canal. A complete blood count is done to assess blood loss. If lung damage is suspected, a chest x-ray and consultation with a thoracic surgeon are indicated; if damage to the abdominal organs is suspected, a consultation with an abdominal surgeon and laparoscopy (if there are sufficient grounds). Suspicion of damage to a large vessel is grounds for consultation with a vascular surgeon; suspicion of nerve damage is grounds for consultation with a neurosurgeon.

Treatment of a puncture wound

On prehospital stage in case of mild bleeding, the skin around the wound should be washed and disinfected, and then a sterile bandage should be applied. In case of massive bleeding, it is necessary to use one of the methods to temporarily stop the bleeding (apply a tourniquet or a pressure bandage, perform wound tamponade). If a sharp object (pin, sharpening) remains in the wound, it should not be removed, as this may lead to increased bleeding and the development of shock. All patients with puncture wounds must be immediately evacuated to a specialized medical facility.

Orthopedic traumatologists treat fresh puncture wounds without damaging internal organs. Patients with suspected damage to internal organs, nerves and blood vessels are referred to the appropriate specialists: thoracic surgeons, abdominal surgeons, cardiac surgeons, urologists, vascular surgeons, neurosurgeons, etc. Treatment of infected puncture wounds is carried out by surgeons.

Patients with deep wounds, muscle damage and significant blood loss should be hospitalized in the trauma department. For minor soft tissue injuries, outpatient treatment at the emergency room is possible. In the postoperative period, UHF and antibiotic therapy are prescribed.

Damage to an internal organ is an indication for appropriate abdominal surgery. If the lung is injured, a thoracotomy is performed, if the abdominal organs are damaged, a laparotomy is performed, etc. The doctor carries out an inspection, suturing the damaged organ and performs other medical measures (the list of measures and tactics of surgical treatment depends on the characteristics of the wound). All patients with internal organ damage are hospitalized.

Infected wounds are opened, washed and drained. Local treatment is carried out against the background of antibiotic therapy. First, broad-spectrum antibiotics are used, then the drug is prescribed taking into account the sensitivity of the detected microorganisms. Depending on the patient’s condition, treatment can be either inpatient or outpatient.

Prognosis and prevention

The prognosis for uncomplicated stab and stab wounds is more favorable than for lacerated and lacerated wounds. Relatively clean and smooth edges provide better conditions for healing. At the same time, the risk of developing infection with such wounds is higher than with shallow incised wounds. The outcome of complicated wounds depends on the characteristics of the injury (the severity of damage to certain organs, the amount of blood loss, the presence or absence of shock). Prevention includes measures to prevent injuries.

Possible reasons for the formation of a stab wound are a fall on a pin, a blow from a sharpener, a road accident, work injury, natural disaster. The damage affects nerves, blood vessels and internal organs, and is combined with head injury and bone fractures.

The wound is characterized by an entrance hole, a wound channel, and an exit hole. The entrance is characterized by edges and ends, with a depression passing into the walls of the wound canal. The outlet, like the inlet, has edges and ends.

depth exceeds its length;
has sharp ends and smooth edges;
during diagnosis, the main incision is noted - from the introduction of a piercing-cutting instrument into the tissue, and the secondary one - from the movement of the blade in the body.

The constructive properties of the instrument make it possible to evaluate stab injuries by the number of structural elements involved in the formation of the wound. The complexity of the forensic medical examination, as well as the amount of information obtained, depends on their number and diversity.

Differences between wounds in surgery and traumatology:

Based on the depth of penetration, wounds are divided into through and blind;
according to the peculiarities of formation - with possible damage to internal organs;
according to the presence of local complications - with massive bleeding, partial prolapse of organs.

Signs

inlet;
wound channel;
outlet.

Peculiarities:

shape: arched, spindle-shaped, angular, slit-shaped;
edges: smooth, with slight subsidence;
shape of ends: angular, sharply rounded, p-, m-, g-shaped;
wound channel: slit-like, with even smooth walls, with a protruding subcutaneous tissue, the depth does not necessarily correspond to the length of the instrument; it changes under the pressure of the organs and when the position of the body changes.

Output damage

Damage of this nature is possible with through and through stab wounds. The outlet hole follows the shape of the inlet hole, its edges are smooth, without precipitation, the drying border is not expressed or expressed to a relatively small extent.

The actions of the handle, limiter, and bit are not tracked. The ends of the exit damage relative to the butt part of the blade are rounded or U-, M-shaped; opposite ends are sharp. The length of the outlet hole is less than the inlet hole. The number of affected hairs on the inlet side exceeds the amount on the outlet side.

Damage to skin tissue

The origin of stab wounds is a blow with a knife or other similar instrument. Their formation involves: the blade, the bevel of the back of the knife, the sharp end, and when the tool is fully inserted into the body, the heel of the blade. The smaller the angle of action of the blade to the surface, the more clearly noticeable is the effect of the bevel of the butt. The wound on the skin follows the shape of an angle with an apex corresponding to the area where the tip is inserted. The lines creating the sides of the angle are located according to the movement of the blade and the bevel of the butt.

Formation phases:

in the phase of blade penetration, tension and compression of the tissues occurs under the influence of the tip, and then, with the removal of the tool, they are cut under the tip and ruptured;
cutting tissue along the line of movement of the blade from the side of the sharp edge and simultaneous pushing away of tissue with a rupture upon contact with the butt;
when removing the blade, the clarity of the cutting action is minimal if the extraction trajectory follows the immersion area of the wounding weapon;
the length of the wound formed corresponds as much as possible to the width of the blade in the area of immersion;
when removing the instrument of damage with emphasis on the blade, its cutting action is more pronounced with the formation of an additional cut;
the direction of the additional cut merges with the main one, if there was no rotation around the longitudinal axis and the victim’s body was static - the length of the wound differs from the width of the blade at the mark of its insertion;
in the presence of a rotational movement with the removal of the blade and a change in the position of the victim, the main and secondary cuts do not coincide.

Muscles and organs

Relatively skeletal muscles the shape of a stab wound depends on the trajectory of the injury relative to muscle fibers. Wounds, the length of which is parallel to the bundles of muscle tissue, are distinguished by their slit-like shape.

If the location is transverse or oblique-transverse, the wound is spindle-shaped, oval with contraction of the transected muscles. Based on the relief of damage to internal organs, one can determine the nature and mechanism of action of the damaging weapon. The dense consistency of the fabrics allows you to evaluate the peculiarities of the movement of the butt, its width, and the volume of the end part of the blade. Heart, liver, kidneys - will show damage with the greatest degree of accuracy.

The predominance of the depth of a stab wound over its length is an unfavorable factor for its healing. Possible manifestation of external or internal bleeding.

Typically, a stab wound to the chest involves the heart and aorta, not just the lung. During a murder, there are many scattered wounds of this type on the body. Shallow wounds are not fatal, but death occurs due to large blood loss.

Victims of a stab wound to the abdominal cavity often experience injuries to the kidneys, liver, spleen, and intestines. The difficulty of diagnosing these organs is that victims have injuries to the chest, head, lose consciousness, experience severe shock or are intoxicated.

First aid

If injured, first aid will prevent complications and consequences and save the life of the victim. But medical assistance in case stab wound should be provided taking into account the classification of damage and combined with further actions.

Help steps:

treat injuries and abrasions with an antiseptic, especially if infected;
avoid touching the wound with your hands to prevent re-infection;
You cannot independently remove foreign bodies that have penetrated into the tissue - this is dangerous due to the risk of infection;
apply a sterile bandage to the wound, providing complete rest to the wounded area;
take the victim to a medical center for a professional examination;
first first aid must be performed within the first minutes after injury, otherwise there is a high risk of death.

Rules for applying a bandage:

position yourself on the side of the injured area of the victim;
When applying a bandage, place the damaged area on the roller;
cut and remove clothing from the victim;
start bandaging from the periphery and strengthening moves.

In case of damage with loss of internal organs, they must not be placed back. The site of injury should be covered with a clean bandage and reported to medical personnel. If there is heavy blood loss, use pressure bandage before the patient arrives at the medical facility.

Application of a tourniquet

Harnesses can be made from available materials: towels, scarves, belts.

Instructions for using the tourniquet:

apply a tourniquet above the level of damage at a distance of 7 cm;
the injured limb must be elevated;
You must first place a cloth on the injured area;
pulling the tourniquet until the bleeding stops;
A piece of paper should be placed under the tourniquet indicating the time of clamping of the vessels;
The tourniquet can be worn for up to two hours in the warm season and up to an hour in the cold season;
take care of the nutrition of the limbs with intact vessels;
loosen the tourniquet briefly, renewing its pressure.

Contour bandages-corsets, “chain mail”, and other cotton-gauze forms are in demand. First aid is provided as quickly as possible and without panic. In a restless state, there is a risk of causing more harm. While waiting for paramedics to arrive, you need to observe the victim's breathing and heartbeat with a readiness to perform resuscitation if he stops - artificial respiration, massage.