Types of wounds and injuries. Symptoms and course of wounds. What are the dangers of wounds and wounds

A common type of injury is a wound - this is damage directly to the skin, mucous membranes with a violation of their anatomical integrity due to mechanical action.

Wounds have different circumstances of occurrence: they can be inflicted by accident, be received in combat or result from a surgical operation. So, let's take a closer look at what wounds are and what first aid needs to be provided.

Classification of wounds and their characteristics

Each injury has its own characteristics, but there are also common signs: internal and / or external, physical pain, gaping, that is, the divergence of the edges of the wound surface.

Depending on how the wound arose, what object it was inflicted, the injury can be: stab, cut, chopped, torn. There are also bruised, bitten, scalped or gunshot wounds.

Scratches, ulcers, erosions, ruptures of organs without violating the integrity of the outer cover of the skin are not considered a wound.

First aid depends on the type of wound. Next, you will be presented with the types of wounds and their characteristics, how they are treated, what first aid should be provided depending on the type of damage.

- this type of wound has a small puncture size, skin damage is insignificant, but the traumatic object very often touches the internal organs, since the depth of the wound is most often greater than its diameter.

Signs of stab injuries:

Smooth edges of the entrance puncture;
Slight redness around;
Bleeding is not strong;
When the striking object remains in the wound, its edges are turned inward.

Stab wounds are most often applied with an awl, nail, sharpening, pin, awl. The longer the tool, the further it penetrates directly into the tissue, the greater the risk of injury. Such types of injuries are found in a criminal environment, in domestic conflicts, as well as in careless handling of sharp objects at work or at home.

- this type of injury occurs due to the action of a sharp flat object. Clear edges can be easily matched, so the wound heals faster.

The severity of injury will depend on the force of impact, on the size of the striking object. The clinic is different, if the object touched the neurovascular bundle, large vessels and nerve fibers are damaged.

Signs of cut wounds:

Wide lumen with different depth;
Deep soft tissue defect;
Profuse bleeding;
gaping surface;
Unbearable pain.

The victim experiences shortness of breath, weakness, dizziness, loss of consciousness is possible. When pathological microorganisms penetrate the wound, symptoms of intoxication occur: chills, headache, nausea, fever.

- are applied with a heavy object with sharp edges: an ax, a shovel, a saber, as well as machine parts in production. They are rare, but a severe degree of damage often leads to disability of patients.

Features of chopped wounds:

Great depth and area of damage;
A massive object causes bruising and reproduction of adjacent tissues;
Moderate gaping of the wound;
Internal organs are often damaged, physiological amputation is possible.

Chopped type of injury has a high risk of infection and purulent complications. causes a noticeable cosmetic defect, normal tissues are replaced by connective tissues.

Irreversible contractures develop in the limbs, in which it is impossible to bend and straighten in one or more joints. The performance of internal organs is impaired.

- appear as a result of application with a blunt object: a stone, a brick, a stick, a bottle. The wound is often shallow, but the high energy of the lesion often damages the internal organs. Wounds on the head cause damage to the brain, chest injuries damage the lungs, the heart.

Types of wounds by the presence and severity of the infectious process

With any injury, various pathological microorganisms enter the affected area, it is believed that all accidental injuries are infected.

According to the severity of infection, wounds are:

Other injury classifications

According to the number of injuries, the wounds are: single, multiple - the wound is applied by one object several times, combined - with the simultaneous injury of several anatomical regions.

By localization, injuries of the head, neck, torso and limbs are distinguished..

By type of complication: complicated and uncomplicated.

Types of wounds depending on the type of healing:

Healing with primary intention without inflammation;
Healing by secondary intention with suppuration and granulation;
Healing under the scab.

Classification of wounds according to the nature of tissue damage:

With damage to soft tissues;
With damage to nerve fibers;
With damage to the artery and large veins;
With damage to bone and joint structures;
With damage to internal organs.

According to the magnitude of damage, injuries are divided into:

With a small area of skin damage- the edges are hardly noticeable, the zone of necrosis is minimal. Such wounds include stab, cut, surgical wounds;
With a large area of damage- there are many non-viable tissues, extensive hemorrhages, for example, with bruised, torn, gunshot injuries.

General first aid for wounds

First aid depends on the type of wound. With any type of injury, it is of great importance. First of all, you need to determine its type. and the bleeding is stopped by applying a tight pressure bandage, - with the help of. Be sure to call an ambulance.

When treating a wound, it is forbidden to perform the following manipulations:

It is necessary to take anti-shock measures: put cold on the wounded area, immobilize, put the victim in a comfortable position for transportation.

During the provision of first aid, you need to constantly talk with the victim, maintain verbal contact with him. When the arrival of medical personnel is not expected soon, try to deliver the victim to a medical facility on their own.

Now you know that in order to provide first aid correctly and in a timely manner, you need to know the types of wounds and their signs.

REGISTRATION No. 4.

TOPIC : FIRST AID FOR WOUNDS.

Literature

Textbook D.V. Marchenko "First aid for injuries and accidents", pages 145-166.

Study questions

1. The concept of injury. Classification and types of wounds.

2. Types of bleeding.

3. General principles of first aid for wounds (stop bleeding, disinfection of the wound, fixation of the limb, anesthesia, safe transportation).

4. Basic rules for applying bandage bandages. Individual dressing package (PPI).

5. The procedure for using a syringe tube.

6. Compliance with standard No. 11.

7. Applying a spiral bandage.

TUTORIAL TEXT:

1. The concept of injury. Classification and types of wounds.

Blood is a universal fluid that ensures the saturation of each organ and tissue of our body with oxygen. In addition to this main transport function (nutrients, enzymes, hormones, vitamins, etc. are delivered along with oxygen by the blood), blood also performs others: it is thermoregulatory (maintaining a constant body temperature due to blood circulation throughout the body), and protective (production antibodies and protection against infection).

That is why any violation of the integrity of the vessel and the vascular system in general as a result of mainly external influences can lead to serious “breakdowns” inside our body and even threaten life.

This situation occurs as a result of injury.

The concept of injury.

So, an injury (or wound) is any violation of the integrity of the skin and underlying tissues (including blood vessels) as a result of an external, mainly mechanical, impact.

Accordingly, the signs of injury will be the following:

Bleeding (as a result of violation of the integrity of the vessel);

Gaping (or divergence of the edges of the wound, roughly following the contour of the injuring object);

Violation of the function of the injured (wounded) part of the body.

In addition, the victim will experience pain, as the nerve trunks are additionally injured. Pain in serious (extensive) injuries is so intense that it can lead to the development of pain shock.

Characteristic for wounds, in addition to the above signs, is the presence of a wound channel - a cavity formed as a result of the passage of a wounding object into the depths of the body. It is by the location of the wounded channel, its direction, length, etc. that one can judge any properties of the injuring object.

Thus, wounds are characterized by the presence of bleeding, gaping and wound channel.

Classification and types of wounds.

All wounds are divided into two large groups:

Penetrating (when the integrity of the internal shells is violated and the injuring object enters one of the cavities of the human body - the skull, chest, abdomen or joints);

Non-penetrating (all other wounds).

According to the mechanism of injury All injuries can be divided into the following types:

Stab (with a small diameter of the outer hole, a rather large depth of the wounded channel is characteristic);

Cut (rather extensive external damage with a shallow depth of the wounded channel);

Chopped (characterized by wide crushing of the edges and extensive internal damage);

Bitten (characterized by the presence of a contour / pattern of teeth) - can be combined with the following type

Torn (extensive external star-shaped damage);

Scalped (with this type of injury, the skin with the subcutaneous base is completely separated from the underlying tissues);

Firearms (as a result of the impact of a firearm - bullets, shots, buckshot, etc.) (Fig. 2).

In turn, gunshot wounds are divided into:

Blind (when there is only an inlet and the injuring projectile is deep in the body);

Through (there are inlet and outlet holes; as a rule, the outlet is slightly larger than the inlet);

Tangential (superficial damage to the skin).

A wound is considered to be a traumatic violation of the mucous and skin integuments, as well as adjacent tissues and even bones. Being at first glance not serious damage, wounds can cause considerable damage to the human body.

The main signs that help determine the presence of a wound:

the appearance of bleeding and gaping;
pain sensations;
the function of the affected organ is impaired;
a state of shock that arose after a large blood loss.

An assistant in the implementation of effective assistance to victims is the classification of wounds, which indicates the types of wound injuries, and how to provide first aid in one form or another.

Classification

This classification includes characteristics that combine such symptoms: the size of the penetration depth, the amount, nature and localization of injury, whether there is a pathogenic microflora in the wounded area, and others.

The nature of the damage can be accidental or intentional (for example, gunshot).

There are the following types of accidental wounds:

stabbed- it is obtained by traumatic contact of a person with a sufficiently long object - a knife, knitting needle or sharpening. There are such features: a small damage with a significant depth, a small size of the inlet, the absence of external bleeding, the presence of damage to deep-lying organs. This species is extremely insidious, since during the first hours the symptoms are not pronounced, and the features of the injury contribute to the penetration of pathogenic microflora, which leads to suppuration and the development of tetanus. That is why this type is needed immediately upon receipt.
cut applied under the influence of a wounding sharp object that has a long pointed shape - knives, razors, glass objects. The features include: tissue destruction at a minimum level, the presence of significant bleeding, mild pain. With all this, this wound heals very favorably. Smooth edges of the wound create good conditions for the treatment of the wound, which is superficial and shallow.
Get chopped wound can be obtained by interacting with a heavy and sharp object - sabers, pitchforks, rakes. Such a wound is characterized by: the deepest penetration, gaping, the presence of bruises and concussions of the brain. The presence of a significant pain syndrome is also not excluded. Based on this, the wound of this type has a complicated processing technique, the development of infections is not excluded.
bruised wound can occur when exposed to the skin with a wide blunt object - an ax or a checker, or as a result of a fall. This type is distinguished by the presence of abrasions, irregularly shaped wounds and its jagged edges, wide gaping. The pain is pronounced as a result of the fact that there is a large area of damage, but the bleeding is insignificant due to instant vascular thrombosis.
Ragged refers to industrial, domestic, and transport injuries. You can get such a wound in case of a strong impact of the object on the skin. A lacerated wound is characterized by: a large loss of blood, general intoxication of the body, poor healing. The wound is usually irregular in shape with jagged edges and filled with blood clots. The feature that distinguishes this species from others is the risk of a high degree of infection, which entails the need for the intervention of doctors.
scalped wound involves detachment of the skin and subcutaneous tissue. A person has a state of shock and profuse blood loss.
The bite of an animal results in bitten wound. Its main features are: the presence of deep skin lesions, a high degree of infection with toxic secretions or saliva. Wounds inflicted by reptiles, arthropods and many other types of insects are manifested by prolonged and severe pain, swelling and a visual change in the color of the skin. The general condition of the victim also worsens significantly. Wounds inflicted by rats, mice, squirrels or cats cause a disease called "rat disease". In the event of an injury that occurs through contact with foxes or dogs, rabies occurs.
Bites from venomous snakes or insects contribute to the formation poisoned wound. During a bite, the poison enters the human body and causes many chemical reactions. The highest danger is the wound resulting from the bite of a poisonous snake. Snake venom is a clear, yellowish discharge that has an acidic reaction. As a result of this injury, the limb doubles in size, the skin acquires a red-blue color, and painful swelling forms. Symptoms may also include headache, dizziness, fainting, and diarrhea.

Wounds are gunshot wounds. This type is obtained as a result of the penetration of a bullet, mine, arrow-shaped element. This injury can be penetrating and non-penetrating, penetrating, blind or tangential. Wound healing is very unfavorable due to the high degree of infection.

Such wounds are distinguished by the presence of an additional classification:

A low-velocity gunshot wound occurs when exposed to a small-caliber weapon or when fired at a great distance.
high-speed wound occurs under the influence of a firearm. In such cases, extensive damage occurs.
shot wound forms a large number of individual wounds. If the shot was fired from a short distance, the occurrence of concussion under the influence of a shock wave is not excluded.

Wounds are classified according to the shape of the wound channel, which look like this:

the presence of inlet and outlet openings is inherent in a through wound;
the presence of only an inlet is observed in a blind wound;
with a tangential wound, only superficial tissues suffer, there is no penetration into the body cavity;
with a deep wound, nerves, blood vessels, bones, internal organs and tendons are damaged;
a tangent wound occurs if the injuring object caused only superficial damage or partially touched the organ.

Types of wounds and their characteristics exist on such a basis as the relationship to the body cavity. In this classification, the following types of wounds are distinguished:

penetrating, receive such injuries as a result of a violation of the integrity of the parietal sheet of the membrane and penetration into the human body. This type is extremely dangerous, since profuse internal bleeding is possible, disruption of vital functions and the development of a severe purulent complication;
the absence of damaged membranes is inherent in a non-penetrating wound.

The next sign is the presence or absence of microflora in the wound. They are classified into the following types:

an aseptic wound is considered an operating wound that occurs under the most sterile conditions. In such wounds, there is practically no microflora, which is why the infectious process does not manifest itself, which allows the wound to heal quickly;
Bacterial-contaminated is considered to be the wound into which microbes have entered, but there is no infectious process. This type includes an accidental wound.
A wound is considered infected when there is a general or local infection. A purulent wound is considered in the presence of a suppuration process.

The severity of the injury can be mild, moderate or severe. To determine this or that degree, you can use:

The size of the external wound.
Depths.
The nature of damage to the human body.
The presence or absence of developing complications.

First aid

After getting acquainted with what wounds can be, due attention should be paid to the rules of emergency care, because it is its effective implementation that will contribute to a speedy recovery.

Clean the wound surface with hydrogen peroxide or other aseptic liquid that does not contain alcohol, so as not to leave a burn.
Treatment of the skin that surrounds the wound is carried out with tincture of iodine or brilliant green.
The next step is to apply a sterile dressing. A tourniquet or pressure bandage will help stop the bleeding. It is forbidden to use cotton wool as an insulating material; it is recommended to use a bandage or ordinary cotton fabric.
It is strictly forbidden to treat a wound in which soil or similar substances are located. In such cases, it is necessary to deliver the victim to a specialist.
The following actions are recommended: applying ice, providing painkillers and giving a comfortable position to the victim, maintaining verbal contact with him.
Having completed all the previous points, it is necessary to deliver the wounded to the nearest medical institution, in which he will undergo surgical treatment.

A wound is an open tissue injury with a violation of the integrity of the skin or mucous membranes. Local symptoms of wounds: bleeding and differences in its edges (hiatus), pain and dysfunction.

All wounds are divided into accidental and operational (aseptic). In the wound, edges, walls and the wound channel are distinguished. Wounds are blind and through. With the blind, there is one hole (inlet), with through ones - two (inlet and outlet). An arbitrary wound contains the so-called wound content - blood clots, areas of destroyed tissues, foreign bodies (pieces of clothing, objects, etc.), various microorganisms. The tissues surrounding the wound are injured to varying degrees, depending on the nature of the injury. Around the wound, there are zones of impact, concussion and local tissue stupor.

Wounds are penetrating and non-penetrating. Penetrating - these are those that penetrate into the body cavity (joint, cranial cavity, chest, abdominal cavity, etc.).

Wounds according to the nature of tissue damage are divided into stab, cut, chopped, bruised, torn, broken, bitten, poisoned, gunshot and mixed.

Incised wounds occur when tissue is damaged by sharp objects - a razor, knife, glass, etc. They are characterized by smooth edges, wide gaps and significant bleeding. Incised wounds are often superficial. When applied, there is no significant tissue trauma, they usually heal without complications.

Stab wounds are inflicted with a bayonet, pitchfork, awl, needle and other similar items. A feature of such wounds is a narrow wound channel and a considerable depth, as a result of which damage to the cavities located behind the course of the wound channel of vessels, nerves and other organs is possible. Since the wound gapes, the wound channel is closed, and microbes can penetrate deep into the tissues. Therefore, stab wounds are often complicated by severe suppuration and.

Lacerations and bruises are typical for transport and industrial injuries, sometimes occur when working in agriculture. They are accompanied by significant slaughter and tissue ruptures, especially skin.

Broken wounds are caused by heavy objects. They occur with railway, automobile and other severe injuries. They are characterized by a significant spread of tissues, sometimes accompanied by detachment of limbs (traumatic amputation), severe shock, large blood loss, and intoxication.

Ragged, bruised and broken wounds heal very poorly due to significant tissue damage, often complicated by infection, in particular anaerobic and tetanus.

Chopped wounds are inflicted with an ax, a saber and other heavy and sharp objects. They are characterized by a significant impact on the tissues and deep, severe disorders of the bones and internal organs.

Bite wounds are accompanied by large and deep injuries, significant contamination, as a result of which they are very often complicated by an acute and putrefactive infection.

Poisoned wounds occur as a result of the penetration of various poisonous substances - military and radioactive poisons, with the bite of snakes, scorpions, etc. They are characterized by a severe course with symptoms of general poisoning of the body. When bitten by snakes (vipers, gyurza, sand efa), the following symptoms occur: severe and prolonged pain, swelling, subcutaneous hemorrhages, bubbles appear filled with bloody fluid. At the same time, general symptoms appear: dizziness, weakness, nausea, sweating, shortness of breath, increased heart rate, a sharp decrease in blood pressure, fainting, collapse - if the poison has entered the bloodstream. Death may occur within hours or days.

In particular, with increased sensitivity of the patient to bee venom, they also pose a certain danger.

Signs. Burning pain, tissue swelling in the bite area, rapidly increasing, weakness, headache, nausea, vomiting. With repeated bites, especially in children, and with increased sensitivity to bee venom, fainting, respiratory and cardiac disorders are possible.

First aid. It is necessary to quickly remove the sting if it remains at the site of the bite, and then apply cotton wool moistened with ammonia or tartar, vodka, a solution of hydrogen peroxide, potassium permanganate to the wound. After that, a cold compress is applied, the victim is given a glass of hot tea to drink.

The defeat of the poison of fish and jellyfish

For fishermen and swimmers, especially for divers, possible injections with spikes and needles of the dorsal fins of fish living in the Black Sea (sea ruff, scorpion and sea dragon).

Signs. Sharp pain and swelling appear at the site of the lesion. When the skin comes into contact with some types of jellyfish, a chemical burn occurs. It manifests itself as a burning pain, a feeling of heat, redness, significant swelling. The victim may have an asthma attack.

First aid. It is not necessary to hastily stop the bleeding when pricking fish fins with needles. The injection site should be lubricated with iodine tincture or manganese solution, and a cold compress should be applied to the wound. When the skin is burned by the tentacles of the jellyfish, its mucus is removed by washing the affected area, lubricating the wound with petroleum jelly and applying a cold compress to it.

Bites from rabid animals

Foxes and wolves. Signs of this disease are restless behavior in dogs, paralysis, and rabies. An animal, having bitten a person, can infect him with rabies even before all these signs appear in it. Therefore, any bite should be considered suspicious for rabies.

An animal showing signs of rabies must be isolated and kept under control.

First aid. The wound after the bite of a rabid animal is smeared with iodine tincture, a bandage is applied to the affected area. Then the victim is sent to outpatient or inpatient treatment and to Pasteur stations for vaccination against rabies.

Gunshot damage

Firearms are understood as damage that occurs when firing from all types of firearms, from explosions of ammunition (cartridges, grenades, mines, explosives) or their parts (primers, fuses, fuses).

Gunshot wounds, especially shrapnel wounds, cause significant trauma and tissue destruction. Depending on the nature of the wound channel, through, blind and tangential wounds are distinguished, as well as penetrating and non-penetrating. Depending on the type of damage, there are soft tissue injuries, gunshot fractures, injuries with damage to blood vessels, nerves, and internal organs. Gunshot wounds are multiple and combined (with damage to various organs). They are characterized by a complex wound channel with significant tissue damage. In the area of the wound channel there is a heavy blow and concussion over a large area due to the so-called side impact, the hydrodynamic action of the projectile that caused the wound. The outlet is larger than the inlet.

- this is tissue damage as a result of mechanical action. Accompanied by a violation of the integrity of the skin or mucous membrane. They differ in the mechanism of occurrence, method of application, depth, anatomical localization and other parameters. May or may not penetrate into natural closed body cavities (abdominal, thoracic, joint cavities). The main symptoms are gaping, pain and bleeding. The diagnosis is made on the basis of the clinical picture, in some cases additional studies are required: radiography, laparoscopy, etc. The treatment is surgical.

Causes of wounds

The cause of traumatic injury is most often a domestic injury, injuries resulting from accidents during sports, criminal incidents, road accidents, industrial injuries and falls from a height are somewhat less common.

Pathogenesis

There are four zones of the wound: the actual defect, the zone of injury (contusion), the zone of concussion (commotion) and the zone with a violation of physiological mechanisms. The defect may take the form of a surface (for example, with scalped or extensive superficial bruised injuries), a cavity (for example, with incised and deep bruised wounds) or a deep channel (with stab, through and some blind gunshot injuries). The walls of the defect are formed by necrotic tissues, between the walls there are blood clots, pieces of tissue, foreign bodies, and in the case of open fractures, there are also bone fragments.

Significant hemorrhages are formed in the contusion zone, bone fractures and ruptures of internal organs are possible. In the concussion zone, focal hemorrhages and circulatory disorders are observed - a spasm of small vessels, followed by their steady expansion. In the zone of disturbed physiological mechanisms, passing functional disorders, microscopic hemorrhages and foci of necrosis are detected.

Healing occurs in stages, through the melting of damaged tissues, accompanied by local edema and fluid release, followed by inflammation, especially pronounced with suppuration. Then the wound is completely cleared of necrotic tissues, granulations are formed in the area of the defect. Then the granulations are covered with a layer of fresh epithelium, and complete healing gradually occurs. Depending on the characteristics and size of the wound, the degree of its contamination and the general condition of the body, healing by primary intention, healing under the scab, or healing through suppuration (secondary intention) is possible.

Classification

Wounds are classified according to many different signs. According to the circumstances of application in traumatology and orthopedics, accidental, combat and operational wounds are distinguished, according to the characteristics of the injuring weapon and the mechanism of damage - cut, torn, chopped, stab, bruised, gunshot, bitten and crushed. There are also wounds that are of a mixed nature, for example, lacerations and stab wounds. Depending on the shape, linear, patchwork, star-shaped and perforated wounds, as well as damage with loss of substance, are distinguished. Wounds with detachment or loss of significant areas of skin are called scalped. In the case when, as a result of an injury, a part of a limb is lost (shin, foot, forearm, finger, etc.), the damage is called traumatic amputation.

Depending on the state of the tissues, wounds with a large and small area of damage are distinguished. The tissues surrounding the wound with a small area of damage, for the most part, remain viable, only the areas that were in direct contact with the traumatic instrument are destroyed. These injuries include stab and cut wounds. Incised wounds have parallel even edges and a relatively shallow depth with a relatively large length, and with timely adequate treatment, as a rule, they heal with a minimum amount of suppuration.

Blood can leak out (external bleeding) and into a natural body cavity (internal bleeding). In the latter case, an accumulation of blood is formed with compression of the corresponding organ and a violation of its function. With hemothorax, compression of the lung is observed, with hemopericardium - the heart, with hemarthrosis - all structures of the joint, etc. Minor superficial injuries, as a rule, are not accompanied by general symptoms. In severe injuries, there is a decrease in blood pressure, tachycardia, pallor of the skin and mucous membranes, nausea, dizziness, weakness and increased respiration.

Diagnostics

With small superficial wounds that are not accompanied by general symptoms, the diagnosis is made by a traumatologist based on the clinical picture. A detailed study is carried out in the process of PST. With extensive and deep wounds with a violation of the general condition, additional studies are needed, the list of which is determined taking into account the location of the damage. For injuries in the chest area, a chest x-ray is prescribed, for damage to the abdomen, an abdominal x-ray, ultrasound or laparoscopy, etc. If a violation of the integrity of blood vessels and nerves is suspected, consultation with a neurosurgeon and a vascular surgeon is required.

Wound treatment

Small superficial injuries are treated in a trauma center. With extensive and deep wounds, open fractures, penetrating wounds, suspected violation of the integrity of internal organs, blood vessels and nerves, hospitalization in the trauma, surgical or neurosurgical department is required. The need for suturing is determined depending on the duration of the traumatic impact. Primary surgical treatment is carried out only on the first day after the injury and in the absence of signs of inflammation.

PHO is performed under local anesthesia or anesthesia. The wound is washed, blood clots and foreign bodies are removed. The edges of the wound cavity are excised, the cavity is washed again and sutured in layers, leaving drainage in the form of a rubber outlet, tube or half-tube. If the area of damage is normally supplied with blood, there are no foreign bodies left, the surrounding tissues are not crushed or crushed, and the edges are firmly in contact throughout (both on the surface and in depth), the wound heals by primary intention. After about a week, signs of inflammation disappear and a tender skin scar forms.

Injuries older than a day are considered as stale and are not subject to suturing. The wound heals either under the scab, which takes a little longer, or through suppuration. In the latter case, pus appears, a demarcation shaft forms around the damage zone. Suppuration is accompanied by a general reaction of the body - intoxication, fever, an increase in ESR and leukocytosis are observed. In this period, dressings and active drainage are carried out. If necessary, purulent streaks are opened.

With a favorable course, after about 2 weeks, the wound is cleared, the healing process begins. At this time, both local and general symptoms of inflammation decrease, the patient's condition returns to normal. The outcome is a rougher scar than with primary tension. With a significant tissue defect, self-healing may not occur. In such cases, plasty with a free skin flap or a displaced skin flap is required.