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Soft Tissue Injuries PowerPoint Presentation

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Description : Check out this medical presentation on Skin Injury, which is titled "Soft Tissue Injuries", to know about the major phases of wound healing, identify host determinants of wound healing, and describe surgical and non surgical treatments of soft tissue injuries.

Tags : Skin Injury, Soft Tissue Injuries, wound healing, surgical, non surgical, treatments

Published on : Jul 05, 2021 | Views : 2204 | Downloads : 5

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Soft Tissue Injuries
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Objectives At the conclusion of this presentation the participant will be able to: Define the major phases of wound healing Identify host determinants of wound healing Describe surgical and non surgical treatments of soft tissue injuries
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Incidence Over 14 million ED visits annually Wounds accounts for 12% of all ED visits Skin first line of defense, therefore, prone to injury
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Mechanism of Injury Special Considerations Tissue Injury Common - blunt & penetrating Injury Environment - dirt, debris, ditch water Occupational Injury - chemical exposure Foreign Body Risk - ex motorcycle road rash Bite Injuries - highly infectious Pressure Injection Injuries- surgical emergency Compression injuries - high risk for necrosis
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Soft Tissue Layers
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Soft Tissue Anatomy
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Soft Tissue Functions
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Phases of Wound Healing Injury Day 1 4 20 ?? Days Proliferation Fibroblasts proliferate in the wound and secrete glycoprotein & collagen Epidermal cells migrate from the wound edge Granulation tissue is formed from macrophages, fibroblasts & new capillaries Remodeling Fibroblasts secrete collagen to strengthen wound Wound remodeling occurs to reorganize fibers Wound contracts increasing tissue integrity Epidermal cells grow over connective tissue to close wound Hemostasis Inflammation Neutrophils secrete chemicals to kill bacteria Macrophages engulf and digest foreign particles and necrotic debris Macrophages release engiogenic substances to stimulate capillary growth Closure
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Wound Healing – By Intention
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Determinants of Wound Healing
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Determinants of Wound Healing
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Determinants of Wound Healing
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Determinants of Wound Healing
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Determinants of Wound Healing
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Initial Assessment Rarely life-threatening alone Always start with ABCDEs Do not be distracted by the wound or injury before addressing the ABCDEs Soft Tissue Injuries
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Controlling External Bleeding Direct pressure Elevate the wound Pressure points Tourniquets
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Acute Wound Major Wound Minor Wound Devitalized tissue Contamination Associated injury Operating Room Inspection r/o other injury Time of injury? Initial assessment ABC’s Control bleeding Tetanus, Antibiotics < 6 hr Clean Close In ED >6 hr Dirty Irrigate Leave Open
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Assessment Medical history Time of injury Allergy history Antibiotics Latex Local anesthetics Tetanus history Occupation Hand dominance
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Patient Symptoms
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Physical Examination Hemostasis Local anesthesia Size/Depth Location Circulation Nerve function Motor function Injury to underlying structures
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Time of Injury to Closure Wound infection risk increases with increased time from injury to repair 6-8 hours acceptable Clean face lacerations Can close up to 24 hrs post injury
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Injury Location Significance Face/neck: Greater blood flow (lower infection risk) Lower extremities Less blood flow (infection prone) Wounds involving tendons, joints, bone Infection prone
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Anesthesia Local Infiltration into wound Field Block Method Inject through intact skin at wound edge Preferred for grossly contaminated wounds Regional Nerve Block Smaller volume required Less tissue distortion Used for digit lacerations
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Topical Anesthetic For Wounds Ideal for lacerations: Small & superficial Scalp and face Advantages: No pain of injection No tissue swelling Minimize bleeding Safe LET (gold standard) Lidocaine 4% Epinephrine 0.1% Tetracaine 0.5% Solution or Gel Saturated gauze on wound 15-30 minutes Avoid Eyes/Mucous membranes End-arteriolar areas-digits
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Topical Anesthetics For Intact Skin Uses: Venipuncture Minor procedures Forms: Gels, sprays, creams, patches Onset Time: Varies by product Short as 5 minutes Long as 60 minutes Some Examples: Eutectic Mixture of Local Anesthetics (EMLA) Lidocaine & Prilocaine 60 minutes to onset Liposomal Lidocaine ELA-Max or LMX4 30 minutes to onset Lidocaine/Tetracaine patch Syntegra (20 minute onset)
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Irrigation Highly effective cleaning Pressure more important than volume Sterile saline common Tap water as effective Avoid providone-iodine, hydrogen peroxide, or detergents (tissue toxic)
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Initial Debridement Removing devitalized tissue Pressure irrigation preferred Mechanical debridement if necessary Caution if extent of tissue devitalization unknown: Wait and see approach
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Hair Removal Pros and Cons Removal to ease wound closure Others advocate presence of hair to assist guiding edge approximation Avoid eyebrow removal Inconsistent regrowth
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Foreign Body Retained foreign body Inflammation/Infection Delayed wound healing Loss of function Litigation if missed X-ray /CT helpful Most difficult to identify Small glass Plastic Wood
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Closed Injuries (skin intact) Contusion Epidermis intact Swelling and pain Hematoma Blood collection under skin Larger tissue damage
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Abrasion Contusion Hematoma
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Laceration Vary in depth: Superficial Deep tissue Vary in appearance: Linear (regular) Stellate (irregular) Assess Underlying damage Contamination Foreign bodies
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Avulsion Tearing, stretching mechanism Full thickness loss of tissue; wound edges cannot be approximated Assess degree of injury, underlying damage
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Degloving Type of avulsion Shearing mechanism Assess degree of tissue loss, underlying injury
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Puncture Wounds Small external opening, deep tissue penetration High risk for infection/ contamination Check tetanus status
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Bite Wounds Infection Risk: Human > Animal Cats > Dogs Assess: Tetanus status Rabies risk Treatment: Elevate area Incision & drainage Antibiotics
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High Pressure Injection Injuries Potentially devastating Prompt surgical debridement Extremity – risk for amputation Damage results from: Impact Ischemia due to swelling Chemical inflammation Secondary infection
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Wound Treatment General Concepts No single treatment for entire healing process Antibiotics Debridement Dressings Surgical Closure Skin Grafts Skin Flaps Nutritional Support
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Which Wounds Need Antibiotics? Highly contaminated wounds Human & animal bites Crush Injuries Stellate lacerations Puncture Wounds Intraoral Lacerations Wounds over open fractures, exposed joint and tendons
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Mechanical Debridement Types: Wet to dry dressings Hydrotherapy Wound Irrigation More painful than other methods May require specialized equipment Nonselective May lead to bleeding, trauma
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Surgical Debridement Use of scalpel, scissors or lasers to remove dead tissue Gold standard of debridement May require serial treatments Dependent on practitioner expertise
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Dressings
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Dressings
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Dressings
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Dressings
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Reconstructive Ladder: Surgical Wound Coverage Simple Complex
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Surgical Interventions Wound Closure Primary Minimal tissue loss Edges well approximated Secondary Wound granulates and closes on its own Larger scar Tertiary Used with contaminated wounds
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Skin Graft Indications Permanent replacement for missing or damaged skin Temporary wound covering to protect against infection. Reconstruction for extensive wounds Closure of extensive wounds
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Full Thickness Grafts for Extensive Tissue Loss
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Flaps Local Flap: Tissue rotated to adjacent area but retains original blood supply Used when tissue “bulk” is needed to fill contour defects Free flap: Tissue from one area detached and transplanted to another Blood supply then surgically reconnected to blood vessels adjacent to the wound
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Flap Coverage of the Elbow: Latissimus Dorsi Local Transfer Flap
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Negative Pressure Wound Therapy Temporary management Removes fluid from extravascular space Reduced edema Improves microcirculation Enhances proliferation of granulation tissue Open cell polyurethane foam dressing ensures an even distribution Wound VAC
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Injury Impact on Nutrition Energy Expenditure Protein & Amino Acid Requirements Metabolic Demand
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Essential Nutrients for Wound Healing Calories Carbohydrates Protein Fats Vitamin A Vitamin C Zinc Water
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Summary Meticulous care of soft tissue injuries can have a tremendous impact on patient outcomes Utilization of appropriate measures during each phase of the healing process can prevent complications and promote normal healing process of soft tissues injuries