M. Y. Podgornyak, M. A. Protchenkov, M. Mitichkin, O. A. Pavlov
{"title":"一种治疗头部大面积皮肤伤口的策略","authors":"M. Y. Podgornyak, M. A. Protchenkov, M. Mitichkin, O. A. Pavlov","doi":"10.25199/2408-9613-2021-8-4-24-29","DOIUrl":null,"url":null,"abstract":"An open wound on the head is an injury (skin tear) of all scalp external layers including dermis, subcutaneous fatty tissue, aponeurosis, muscles, vessels and nerves with intact skull bones and intact neurological reactions [1].Extensive wounds of the external head layers, in addition to a standard threat to the human health, bear an additional risk due to their close localization to the brain. Because of the abundant blood supply to scalp soft tissues, high rate of volumetric blood flow (50–60 milliliters per 100 g of brain tissue), numerous extra-, intracranial arterial and venous anastomoses, there is a real danger of spreading the infection inside the skull and developing meningitis or encephalitis.Problems of care of patients with extensive head wounds, risk of complications that can cause severe consequences determine the relevance of the issue presented in this work.Objective. To analyze treatment results of patients admitted to the emergency department of Mariinskaya State City Hospital in St. Petersburg within three months in 2021 and to develop an optimal tactics for treating patients with extensive wounds of the scalp.Material and research methods. 2245 patients with various types of head injury were admitted to the hospital; 610 (27.2 %) of them had damage of the external scalp layers. Each patient had standard clinical and laboratory examination and multislice computed tomography (MSCT) examination of the head at 64-slice Definition AS (Siemens, Germany) CT scanner. In the emergency department, all patients who were injured by high-energy traumatic objects had the primary surgical debridement; all patients who were injured by low-energy traumatic objects had wound toilet and wound suturing. Three most representative cases with extensive wounds of the external scalp (over 10 cm) with illustrations are presented in the article as clinical examples.Results. All patients had good outcomes. There were no any signs of wound infection either.Conclusion. A thorough primary surgical debridement of scalp wounds with their drainage followed by observation and treatment in the hospital is a necessary condition for successful healing of large scalp wounds.","PeriodicalId":366300,"journal":{"name":"Wounds and wound infections. The prof. B.M. 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Because of the abundant blood supply to scalp soft tissues, high rate of volumetric blood flow (50–60 milliliters per 100 g of brain tissue), numerous extra-, intracranial arterial and venous anastomoses, there is a real danger of spreading the infection inside the skull and developing meningitis or encephalitis.Problems of care of patients with extensive head wounds, risk of complications that can cause severe consequences determine the relevance of the issue presented in this work.Objective. To analyze treatment results of patients admitted to the emergency department of Mariinskaya State City Hospital in St. Petersburg within three months in 2021 and to develop an optimal tactics for treating patients with extensive wounds of the scalp.Material and research methods. 2245 patients with various types of head injury were admitted to the hospital; 610 (27.2 %) of them had damage of the external scalp layers. Each patient had standard clinical and laboratory examination and multislice computed tomography (MSCT) examination of the head at 64-slice Definition AS (Siemens, Germany) CT scanner. In the emergency department, all patients who were injured by high-energy traumatic objects had the primary surgical debridement; all patients who were injured by low-energy traumatic objects had wound toilet and wound suturing. Three most representative cases with extensive wounds of the external scalp (over 10 cm) with illustrations are presented in the article as clinical examples.Results. All patients had good outcomes. There were no any signs of wound infection either.Conclusion. A thorough primary surgical debridement of scalp wounds with their drainage followed by observation and treatment in the hospital is a necessary condition for successful healing of large scalp wounds.\",\"PeriodicalId\":366300,\"journal\":{\"name\":\"Wounds and wound infections. The prof. B.M. 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引用次数: 0
摘要
头部开放性创面是头皮所有外部层包括真皮、皮下脂肪组织、腱膜、肌肉、血管和神经的损伤(皮肤撕裂),颅骨和神经反应完好无损[1]。头部外层的大面积伤口除了对人体健康构成标准威胁外,还因其靠近大脑而具有额外的风险。由于头皮软组织有丰富的血液供应,高容量血流量(每100克脑组织50-60毫升),颅内外动脉和静脉吻合处众多,存在在颅骨内传播感染并发展为脑膜炎或脑炎的真正危险。大面积头部创伤患者的护理问题,可导致严重后果的并发症风险决定了本工作中提出的问题的相关性。分析2021年三个月内圣彼得堡马林斯卡娅州立城市医院急诊科收治的患者的治疗结果,并制定治疗大面积头皮伤口患者的最佳策略。材料和研究方法。收治各类颅脑损伤患者2245例;其中610例(27.2%)有头皮外层损伤。每位患者均接受标准的临床和实验室检查,并在64层Definition AS (Siemens, Germany) CT扫描仪上进行头部多层CT (MSCT)检查。在急诊科,所有被高能创伤物损伤的患者都进行了初级手术清创;低能创伤物致伤患者均有创面冲洗和创面缝合。本文以3例最具代表性的外头皮大面积创面(大于10cm)为例,并附图。所有患者预后良好。也没有任何伤口感染的迹象,结论。对大面积头皮创面进行彻底的外科清创及引流,并在医院进行观察和治疗,是大面积头皮创面成功愈合的必要条件。
A tactics for treating large skin wounds on the head
An open wound on the head is an injury (skin tear) of all scalp external layers including dermis, subcutaneous fatty tissue, aponeurosis, muscles, vessels and nerves with intact skull bones and intact neurological reactions [1].Extensive wounds of the external head layers, in addition to a standard threat to the human health, bear an additional risk due to their close localization to the brain. Because of the abundant blood supply to scalp soft tissues, high rate of volumetric blood flow (50–60 milliliters per 100 g of brain tissue), numerous extra-, intracranial arterial and venous anastomoses, there is a real danger of spreading the infection inside the skull and developing meningitis or encephalitis.Problems of care of patients with extensive head wounds, risk of complications that can cause severe consequences determine the relevance of the issue presented in this work.Objective. To analyze treatment results of patients admitted to the emergency department of Mariinskaya State City Hospital in St. Petersburg within three months in 2021 and to develop an optimal tactics for treating patients with extensive wounds of the scalp.Material and research methods. 2245 patients with various types of head injury were admitted to the hospital; 610 (27.2 %) of them had damage of the external scalp layers. Each patient had standard clinical and laboratory examination and multislice computed tomography (MSCT) examination of the head at 64-slice Definition AS (Siemens, Germany) CT scanner. In the emergency department, all patients who were injured by high-energy traumatic objects had the primary surgical debridement; all patients who were injured by low-energy traumatic objects had wound toilet and wound suturing. Three most representative cases with extensive wounds of the external scalp (over 10 cm) with illustrations are presented in the article as clinical examples.Results. All patients had good outcomes. There were no any signs of wound infection either.Conclusion. A thorough primary surgical debridement of scalp wounds with their drainage followed by observation and treatment in the hospital is a necessary condition for successful healing of large scalp wounds.