整形外科 陈杰峰医师.pptVIP

整形外科 陳杰峰醫師 外科傷口分類 Class Ⅰ:乾淨Clean Elective surgical incisions not involving the GI , GU , or respiratory tracts No inflammationencountered No drains Infection rate1-2% 外科傷口分類 Class Ⅲ:染污Contaminated Fresh trauma wounds Gross spillage from GI tract GU or biliary tractentered, and urine orbile is infected Nonpurulent inflammation Major break in steriletechnique No drains Infection rate10-20% Factors Contributing to Wound Infections Crush injury Necrotic tissue Denervation Wound maceration Obesity Prolonged surgery Age Trauma Malnutrition Immune suppression Arterial ischemia Venous congestion Lymphedema Foreign bodies Categories of Wound Healing 1. Primary closure: Within 24 hours. Good scar. 2. Delayed Primary Closure: Cleansed, debrided for 4 to 5 days Contaminated, human or dog bite 3. Secondary closure: Heal by granulation and  reepithelialization infected wound scar 4. Partial thickness wounds Categories of Wound Healing Category 1 Primary wound healing or healing by first intention occurs within hours of repairing a full-thickness surgical incision. This surgical insult results in the mortality of a minimal number of cellular constituents. Categories of Wound Healing Category 2 (Tertiary wound closure) delayed primary wound healing This type of healing may be desired in the case of contaminated wounds. By the fourth day, phagocytosis of contaminated tissues is well underway, and the processes of epithelization, collagen deposition, and maturation are occurring. Foreign materials are walled off by macrophages that may metamorphose into epithelioid cells, which are encircled by mononuclear leukocytes, forming granulomas. Usually the wound is closed surgically at this juncture, and if the cleansing of the wound is incomplete, chronic inflammation can ensue, resulting in prominent scarring. Categories of Wound Healing Category 3 (secondary healing) h