皮肤与软组织疾病.pptx

皮肤与软组织外科伤病disorders of skin and subcutaneous tissueChapter 1皮肤的解剖Anatomy of Skin皮肤的组成1、表皮（epidermis) 2、真皮（dermis) 血管、淋巴管、神经末梢及大、小汗腺、皮脂腺3、皮下组织(subcutaneous fat tissue) 毛囊、甲等附属器Chapter 2Trauma of skin and soft tissueLacerations撕裂伤 and Fingertip指尖 and Complex Soft Tissue Injuries1、Sprain扭伤 2、contusion挫伤 3、Pricking wound刺伤4、Foreign body异物5、Incised wound割裂伤6、Bites and stings叮咬伤Sprain扭伤 、contusion挫伤鈍性暴力软组织闭合性损伤肿胀、疼痛、皮下淤血，甚至关节活动障碍24H内不宜热敷及活血化瘀关节扭伤需固定2周Pricking wound刺伤、Foreign body异物锐器戳刺皮肤伤口小易造成深部组织损伤易继发化脓性感染和破伤风伤口处理术后应用抗生素及破伤风抗毒素异物：透光、不透光Incised wound割裂伤锐器割裂大血管破裂致休克神经损伤致运动感觉丧失肌腱损伤致运动障碍伤口处理包括神经肌腱术后应用抗生素及破伤风抗毒素Bites and stings叮咬伤兽咬伤 animal bites 清创：3%过氧化氢、生理盐水 原则上不一期缝合伤口 术后应用抗生素及破伤风抗毒素、狂犬疫苗毒蛇咬伤 snake bites 神经毒：延髓及脊神经细胞，0.5~2H呼吸肌 麻痹。 金环蛇、银环蛇 血液毒: 溶组织、溶血及抗凝作用致组织坏死感染。 竹叶青、五步蛇阻断静脉血、淋巴液回流、清创服用蛇药：南通季得胜蛇药、广州何晓生蛇药 口服10#T.I.D 或外用 应用抗生素及破伤风抗毒素、抗蛇毒血清气管切开蜂螫伤 bee stings：过敏反应及组织损害蜈蚣咬伤centipede bites：同上蝎螫伤scorpion stings：类似毒蛇咬伤局部处理：挑出蜂刺，避免挤压全身处理:补液、肾上腺皮质激素、抗组胺药Surgical Wound Types ClassificationType I (Clean): infection risk 1 to 5 %Type II (Clean-contaminated): infection risk 5 to 10 %Type III (Contaminated): infection risk 10 to 15 %Type IV (Dirty): infection risk 30 to 50 %Surgical Wound Types Classification (continued)Type I (Clean)NontraumaticNo inflammation present无炎症表现Type II (Clean-contaminated)Nonsterile body region体内无菌环境 entered (gastro-intestinal胃肠道, urogenital生殖道, biliary tract胆道 or respiratory tract呼吸道, oropharynx鼻咽道, etc. )Type III : Contaminated WoundsGross spillage溢出 from gastro-intestinal tractInfected gastro-intestinal, urogenital生殖道 or biliary tract enteredFresh traumatic wound ( through unprepared skin未消毒的皮肤)Type IV : Dirty WoundsWounds associated with perforated viscus内脏(stomach,bowel,gallbladder)Traumatic wounds with :Imbedded foreign body异物植入Fecal contamination粪便污染Delayed presentation 12 to 24 hours for face or scalp 6 hours elsewhere on bodyProper Sequence of Steps for Routine Wound Care Repair1. Adequately expose the wound area充分暴露创面2. Remove superficial contami