外伤的处理概要1.pptVIP

Principles of Wound Management Abdelrahman S-E Imbabi, FRCSEd Assistant Professor of SurgeryUniversity of Khartoum Traumatic Wounds Usually untidy Damage to tissues is extensive, and extent unclear – such as gunshot or blast injuries, crush injuries, lacerations or burns And contaminated Most traumatic wounds are potentially contaminated, and hence likely to be infected Wound healing Healing involves many humoral, chemical, environmental and cellular factors The process may be considered as occurring in three overlapping phases Phases of healing Phase I: Vasodilatation of capillaries in wound edges and migration of plasma, leucocytes and macrophages into the wound space Phase II: Development of granulation tissue, a vascular and cellular tissue comprising new vascular endothelium, fibroblasts, macrophages and mast cells Phase III: Remodeling; the wound assumes the appearance of an avascular fibrous scar Building blocks of healing Collagen Synthesized within fibroblasts, extruded as soluble fibrils which become insoluble, thicker and tougher due to intermolecular cross-links Proteoglycans Large protein polysaccharide complexes also synthesized by fibroblasts during the 2nd phase, responsible for stabilization and maturation of collagen Fibronectin Polymorphic glycoprotein, synthesized by fibroblasts during 2nd phase and form an immobile mesh for cell-to-cell and cell-matrix adhesion Chemical factors Platelets, leucocytes, mast cells and the complement system release Histamine Serotonin Kinins (bradykinin and kallidin) Prostaglandins Connective-tissue activating peptide The epidermal growth factor (urogastrone) And other factors Chemical factors These factors are directly involved in the healing process by inducing vasodilatation, capillary engorgement and increased vascular permeability, thus stimulating the synthesis of granulation tissue, immigration of leucocytes and activation of wound fibroblasts The fibroblast Fibroblasts are activated by macrophages and