Treatment and Management of Wounds and Abscesses by Dr. Gyan Dev Singh
VCP-511, TOPIC:
Treatment and
management of wounds
and abscess
Dr Gyan Dev Singh, Assistant professor,
VCC, BVC, Patna-14
Abscess
•
Abscesses are circumscribed collections of purulent material (pus) in
a cavity
•
Corynebacterium, Pseudomonas, Streptococcus and Staphylococcus
•
Abscess consists of a wall, pyogenic membrane and pus (Liquor puris).
•
Pyogenic membrane controls spread of infection, and helps in
phagocytosis and granulation tissue formation
•
Pus contains necrosed tissue, dead bacteria, leukocytes and proteins
of blood and tissues.
•
Pus cells mainly consist of polymorphonuclear leukocytes along with
a few mononuclear cells.
•
Pus is alkaline in nature and yellow in colour.
•
Pus serum will not clot, since the fibrin of exudates is digested by the
proteolytic enzymes of the leukocytes
Classification of abscess
•
Abscess may be classified as:
•
Acute Abscess (Hot abscess):
Inflammatory symptoms are more active.
•
Chronic Abscess (Cold abscess):
Inflammatory symptoms are less active.
•
Chronic abscess may be:
•
Hard with inspissated pus,or
•
Soft with liquid pus and thin abscess wall.
•
Superficial or deep abscess:
based on location
Etiology of abscess
•
Pyogenic organisms like Staphylococci, Streptococci, Escherichia
coli and Pseudomonas aeruginosa.
•
Specific organisms like Corynebacterium pyogenes, Actinomyces bovis
etc.
•
Chemicals like mercuric chloride and Zinc chloride.
Common seats of abscess formation
•
Cattle:
Yoke, udder and prominences
•
Horses:
Shoulders, sub-maxillary and post pharyngeal lymph nodes.
•
Dogs:
Anal region, and mammary glands.
A
C
U
T
E
A
B
S
C
E
S
S
•
Acute abscess forms in 3 to 5 days following infection.
•
In long duration abscess, the liquid part is absorbed and the solid part is left. This is
called Inspissated Pus.
Symptoms
•
Acute superficial abscess appears as a local painful swelling.
•
The dead tissues and dead inflammatory cells are continuously thrown into the cavity
which leads to a gradual increase in the amount of pus.
•
Thus the abscess enlarges till it reaches the surface of skin or mucous membrane.
•
The center of abscess becomes soft
(pointing)
and later ruptures, discharging pus.
•
Local acute inflammatory symptoms without fever are observed in
superficial abscess.
•
Deep abscess
has no local symptoms, but fever and pain on manipulation of the part are
evident.
C
H
R
O
N
I
C
A
B
S
C
E
S
S
(
C
o
l
d
a
b
s
c
e
s
s
)
•
A chronic abscess develops slowly
without any inflammatory
symptoms.
•
It may be
painless or slightly painful
.
•
Primary chronic abscess usually occurs from repeated injuries and
observed on the prominences of limbs and ribs due to bed sores.
•
Secondary chronic abscess develops in the course of various local
affections.
•
Chronic abscess may be hard in consistency surrounded by fibrous
tissue and containing small amount of pus or it may be soft and thin
walled with comparatively larger amount of pus.
T
R
E
A
T
M
E
N
T
•
maturation of abscess by using liniments, fomentations and mild
blisters.
•
Drainage of pus
•
Tincture of Iodine soaked gauge packing (Gauze soaked with 0.5%
silver nitrate is best against most of the micro-organisms)
WOUND-CLASSIFICATION,
SYMPTOMS, DIAGNOSIS AND
TREATMENT
Open wounds
Septic wound
Contaminated wound
Asceptic wound
granulating
Bite wound
abrasion
Gunshot wound
Punctured wound
Incised wound
Lacerated wound
Penetrating
perforating
Close wound
S
Y
M
P
T
O
M
S
O
F
W
O
U
N
D
•
Localized pain and bleeding.
•
Gaping of the lips of wound.
•
Weakness, paralysis or a loss of function in a dependent portion.
•
Febrile disturbances in severe septic wound.
•
Neuritis extending along the course of the nerve involved in the
wound.
F
A
C
T
O
R
S
A
F
F
E
C
T
I
N
G
W
O
U
N
D
H
E
A
L
I
N
G
•
LOCAL FACTORS:
•
Tissue vascularity
•
Infection
•
Topical medications
•
Lavage and dressings
•
Presence of
foreign bodies
•
Obliteration of dead space
•
Ionizing radiation
•
Movement
•
Mutilation
Systemic factors
•
Advanced age
•
Nutrition
•
Protein
•
Glucose
•
Iron
•
Minerals like zinc, copper
•
Vitamins A and B complex
•
Vitamin C
•
Carbohydrates and fats
M
E
D
I
C
A
T
I
O
N
•
Anti-inflammatory
drugs
•
Chemotherapeutic agents
•
Anticoagulant drugs
•
Most
NSAIDs
lower resistance to infection and ultimately delay healing
S
Y
S
T
E
M
I
C
D
I
S
E
A
S
E
S
•
malignancy, uncontrolled diabetes, renal and hepatic disturbances
delay healing process.
•
Malignancy
(by altering metabolism, producing chachexia, and
minimizing inflammatory cell division.)
•
Uremia
•
diabetes
M
A
N
A
G
E
M
E
N
T
O
F
W
O
U
N
D
S
•
Contusions:
are treated with cold and astringent applications to minimize
extravasation.
•
Haematomas:
when small get absorbed other wise they may have to be
opened and treated.
•
Open wounds:
surgical or aseptic wound, contaminated and septic wound or
infected wounds.
Surgical or aseptic wounds
•
Surgeon should avoid
drying of the tissue, excessive trauma and haemorrhage
•
Prophylaxis against tetanus.
•
Dependent drainage should be provided if haemotoma or seroma formation is
expected.
•
Suture should be supported upto healing time
8 -14 days
•
Antibiotics as a therapeutic or prophylactic measure.
•
Local application of Fly repellents – hot summer months.
•
The patient and the affected injured part should be kept at rest.
Contaminated wound
•
A fresh wound gets contaminated when it is more than 4 -5 days old.
•
The principal therapeutic strategies of the open and contaminated
wound are to convert it into a clean closed wound.
S
E
P
T
I
C
W
O
U
N
D
O
R
I
N
F
E
C
T
E
D
W
O
U
N
D
•
Debridement
•
Lavage
•
Wound drainage
•
Antimicrobial therapy
•
Sterile protective bandaging
Thank you
Dr. Gyan Dev Singh, an Assistant Professor at VCC, BVC, Patna-14, provides valuable insights on the treatment and management of wounds and abscesses. Abscesses, categorized as acute or chronic, are collections of pus caused by organisms like Staphylococci and Streptococci. This informative content covers abscess classification, etiology, common formation sites, and symptoms of acute abscesses in detail.
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Presentation Transcript
VCP-511, TOPIC: Treatment and management of wounds and abscess Dr Gyan Dev Singh, Assistant professor, VCC, BVC, Patna-14
Abscess Abscesses are circumscribed collections of purulent material (pus) in a cavity Corynebacterium, Pseudomonas, Streptococcus and Staphylococcus Abscess consists of a wall, pyogenic membrane and pus (Liquor puris). Pyogenic membrane controls spread of infection, and helps in phagocytosis and granulation tissue formation
Pus contains necrosed tissue, dead bacteria, leukocytes and proteins of blood and tissues. Pus cells mainly consist of polymorphonuclear leukocytes along with a few mononuclear cells. Pus is alkaline in nature and yellow in colour. Pus serum will not clot, since the fibrin of exudates is digested by the proteolytic enzymes of the leukocytes
Classification of abscess Abscess may be classified as: Acute Abscess (Hot abscess): Inflammatory symptoms are more active. Chronic Abscess (Cold abscess): Inflammatory symptoms are less active. Chronic abscess may be: Hard with inspissated pus,or Soft with liquid pus and thin abscess wall. Superficial or deep abscess: based on location
Etiology of abscess Pyogenic organisms like Staphylococci, Streptococci, Escherichia coli and Pseudomonas aeruginosa. Specific organisms like Corynebacterium pyogenes, Actinomyces bovis etc. Chemicals like mercuric chloride and Zinc chloride.
Common seats of abscess formation Cattle: Yoke, udder and prominences Horses: Shoulders, sub-maxillary and post pharyngeal lymph nodes. Dogs: Anal region, and mammary glands.
ACUTE ABSCESS ACUTE ABSCESS Acute abscess forms in 3 to 5 days following infection. In long duration abscess, the liquid part is absorbed and the solid part is left. This is called Inspissated Pus. Symptoms Acute superficial abscess appears as a local painful swelling. The dead tissues and dead inflammatory cells are continuously thrown into the cavity which leads to a gradual increase in the amount of pus. Thus the abscess enlarges till it reaches the surface of skin or mucous membrane. The center of abscess becomes soft (pointing) and later ruptures, discharging pus. Local acute inflammatory symptoms without fever are observed in superficial abscess. Deep abscess has no local symptoms, but fever and pain on manipulation of the part are evident.
CHRONIC ABSCESS CHRONIC ABSCESS (Cold abscess) (Cold abscess) A chronic abscess develops slowly without any inflammatory symptoms. It may be painless or slightly painful. Primary chronic abscess usually occurs from repeated injuries and observed on the prominences of limbs and ribs due to bed sores. Secondary chronic abscess develops in the course of various local affections. Chronic abscess may be hard in consistency surrounded by fibrous tissue and containing small amount of pus or it may be soft and thin walled with comparatively larger amount of pus.
TREATMENT TREATMENT maturation of abscess by using liniments, fomentations and mild blisters. Drainage of pus Tincture of Iodine soaked gauge packing (Gauze soaked with 0.5% silver nitrate is best against most of the micro-organisms)
WOUND-CLASSIFICATION, SYMPTOMS, DIAGNOSIS AND TREATMENT
Open wounds Incised wound Penetrating perforating Lacerated wound granulating Bite wound Punctured wound abrasion Gunshot wound Asceptic wound Contaminated wound Septic wound
SYMPTOMS OF WOUND SYMPTOMS OF WOUND Localized pain and bleeding. Gaping of the lips of wound. Weakness, paralysis or a loss of function in a dependent portion. Febrile disturbances in severe septic wound. Neuritis extending along the course of the nerve involved in the wound.
FACTORS AFFECTING WOUND HEALING FACTORS AFFECTING WOUND HEALING LOCAL FACTORS: Tissue vascularity Infection Topical medications Lavage and dressings Presence of foreign bodies Obliteration of dead space Ionizing radiation Movement Mutilation
Systemic factors Advanced age Nutrition Protein Glucose Iron Minerals like zinc, copper Vitamins A and B complex Vitamin C Carbohydrates and fats
MEDICATION MEDICATION Anti-inflammatory drugs Chemotherapeutic agents Anticoagulant drugs Most NSAIDs lower resistance to infection and ultimately delay healing
SYSTEMIC DISEASES SYSTEMIC DISEASES malignancy, uncontrolled diabetes, renal and hepatic disturbances delay healing process. Malignancy (by altering metabolism, producing chachexia, and minimizing inflammatory cell division.) Uremia diabetes
MANAGEMENT OF WOUNDS MANAGEMENT OF WOUNDS Contusions: are treated with cold and astringent applications to minimize extravasation. Haematomas: when small get absorbed other wise they may have to be opened and treated. Open wounds: surgical or aseptic wound, contaminated and septic wound or infected wounds.
Surgical or aseptic wounds Surgeon should avoid drying of the tissue, excessive trauma and haemorrhage Prophylaxis against tetanus. Dependent drainage should be provided if haemotoma or seroma formation is expected. Suture should be supported upto healing time 8 -14 days Antibiotics as a therapeutic or prophylactic measure. Local application of Fly repellents hot summer months. The patient and the affected injured part should be kept at rest.
Contaminated wound A fresh wound gets contaminated when it is more than 4 -5 days old. The principal therapeutic strategies of the open and contaminated wound are to convert it into a clean closed wound.
SEPTIC WOUND OR INFECTED WOUND SEPTIC WOUND OR INFECTED WOUND Debridement Lavage Wound drainage Antimicrobial therapy Sterile protective bandaging
