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a mechanical injury to organic tissues with disruption of the continuity of such structures as skin and mucous membranes. Wounds are characterized by three basic local symptoms: (1) separation of the edges of the wound, which varies with the extent, depth, and location of the wound, (2) pain, and (3) bleeding; the last two result from injury to nerves and blood vessels. In addition to causing anatomical and functional disturbances to tissues and organs, some wounds are dangerous because they may lead to acute anemia or shock as a result of heavy bleeding or to wound infections, including such anaerobic infections as gangrene and tetanus.
Wounds are classified according to the causes of the injury as surgical, accidental, or combat wounds, according to the type of injury to the tissues as incised, puncture, gash, contused, bite, flap, crushed, or gunshot wounds, according to the presence of a wound infection as aseptic or infected wounds (practically all accidental wounds become infected), and according to penetration into body cavities, such as the pleural, abdominal, cranial, or articular cavities, as penetrating or nonpenetrating wounds.
Penetrating wounds are dangerous because the cavity may become infected or the organs within the cavity, for example, the lungs, liver, stomach, or intestine, may be injured. Puncture wounds are often quite deep, which may result in the trauma of organs and blood vessels located deep in the wound. A large number of crushed nonviable tissues and blood clots that encourage infection (especially anaerobic infection) are characteristic of contused, lacerated, and gash wounds. Wounds caused by bites may be complicated by the development of a severe infection; rabies, for example, is caused by pathogenic flora entering the wound from the mouth of the diseased animal.
The healing of a wound depends on the nature of the wound and on the presence or absence of infection. A linear incised wound that is not infected heals by first intention if the gap is corrected and the edges of the wound are brought together by sutures, clips, or strips of adhesive tape. The gap is filled with blood clots, fibrin, and the cells of injured and dead tissues; the last subsequently either tear away from the wound with discharges or undergo phagocytosis, which results in the wound cavity filling with special cells called fibroblasts. The blood capillaries start growing together from the edges of the wound at the end of the second day. By the fifth to seventh days, cicatricial tissue forms from the fibroblasts and new blood vessels and regeneration of the epithelium covering the tissue starts. The conversion of immature connective tissue into a permanent scar continues for several months.
Wounds that heal by second intention include wounds whose edges were not joined (that is, the cavity remained), as well as infected wounds and wounds complicated by suppuration. Healing by second intention is a longer process because it goes through a stage during which granulations develop; the granulations fill the wound cavity and gradually epithelialize from the edges of the wound. Severe systemic diseases, exhaustion, and hypovitaminoses cause even surgical wounds to heal by second intention.
First aid for wounds should be rendered immediately at the site of the accident by the victim himself or persons nearby. The purpose of first aid is to prevent the secondary contamination of the wound, to stop the bleeding, and to permit the wound to rest. The skin around the wound is cleaned with cotton or gauze moistened with water, ether, or alcohol (fluid must not enter the wound), and a sterile pad is applied to the wound and secured by a bandage, Kleol, or adhesive tape. Slight bleeding can usually be halted by applying a pressure bandage. In addition to a bandage, a tourniquet is applied on the part of the extremity above a wound if arterial bleeding is copious. If there is both a wound and a bone fracture, the extremity is immobilized.
Qualified first aid, or first surgical treatment, is provided by a surgeon, who removes nonviable tissues, blood clots, and foreign bodies from a wound, ligates bleeding vessels, excises the edges and bottom of contused, lacerated, and crushed wounds (which become incised wounds after treatment), and sews wounds up with interrupted sutures; all these procedures promote healing by first intention. A delayed suture can be applied (in two or three days) that draws the edges of an infected wound together, if it is not suppurating. Specific preventive measures are taken to prevent tetanus in cases of lacerated and contused wounds contaminated by dirt, prophylactic injections of anti-gangrene serum are made, and measures are taken to prevent posttraumatic sepsis.
Physical therapy, including ultraviolet irradiation treatment and treatment with ultrashort waves, and administration of antiseptics, hypertonic saline solutions, solutions of potassium permanganate, antibiotics, and sulfanilamide preparations, is used extensively in the case of suppurative wounds.
REFERENCESStruchkov, V. I. Obshchaia khirurgiia. Moscow, 1966.
Kamaev, M. F. Infitsirovannaia rana i ee lecheme, 2nd ed. Moscow, 1970.
R. T. PANCHENKOV and A. G. KISSIN
What does it mean when you dream about a wound?
The term wound is often used as a metaphor for the impact of negative emotional experiences. The healing of old wounds may thus be indicated by this dream symbol.