伤口判别与包扎-高雄医学大学国际事务处.pdf

For 2009 KMU International Volunteers 2009 高醫國際志工團 傷口判別與包紮 李書欣 高雄醫學大學 外科學 助理教授 高雄醫學大學整形外科主治醫師 2009-5-5 皮膚之構造 1.Epidermis,最外層為 keratinous layer 2.Dermis,較epidermis 厚 (1mm~4mm不等),含有 vessels, nerve, sensory organs, sebaceous glands, sweat glands and hair follicles 3.Sub-cutis,位於dermis 下方,含fat cells Wound healing 傷口癒合 • Stages 1. Coagulation 2. Inflammation 3. Proliferation- epithelialization, fibroplasia and matrix formation, angiogenesis 4. Wound contraction 5. Remodeling Cytokines 血管新生 表皮增生 膠原蛋白 基質形成 外科處理 • Wound healing by primary intention (直接 縫合) Oppose of the wound edges. • Wound healing by secondary intention (不縫,等待慢慢長) 1. Deposition of matrix proteins 2. Neovascularization to form granulation tissue 3. Migration of keratinocytes 痂皮 Open wound: epithelium migrates beneath a desiccated crust 上皮細胞在痂皮下方慢慢前進 Partial thickness skin loss….wound care with SSD. Need debridement later. 11 days later Debridement 潮濕環境有利上皮細胞前進 Biobrane (Semi-occlusive dressing) H2SO4 6 weeks Chemical burn Avulsion skin necrosis Debridement Redness, Pus Left 2nd toe gangrene, left foot fascitis Amputation the left 2nd toe Debride the wound base Free flap reconstruction + skin graft Dry gangrene 92