The main objectives of wound treatment are as follows:

First, remove foreign body pollution and necrotic tissue.

Second, avoid the formation of blood clots.

Third, repair important structures in time.

Fourth, early repair of wounds can reduce the formation of scars.

Therefore, in fact, the treatment of the wound is to check the wound well, debride the bleeding point, take out the foreign body and rinse it clean, and then sew it properly.

The best conditions for wound healing are:

First, there is no foreign body, hematoma or infection between the wounds.

Second, the winding faults are aligned with each other.

Third, after suture, the suture has enough strength to resist the tension of the wound itself.

Fourth, every suture should have a proper distance, so as not to affect the blood circulation of the tissue near the wound.

After suture, some tiny bleeding spots in the wound will inevitably continue to ooze blood. At this time, it is necessary to place a drainage tube or apply a little pressure outside, which can not only stop bleeding, but also reduce the degree of edema. Therefore, the wound care after suture is very simple, because it has been thoroughly cleaned up during wound treatment, especially after surgery; But if there is bleeding or a wound that may be infected, it needs to be replaced.

Theoretically speaking, wounds are more likely to be contaminated, so only changing contaminated dressings into clean dressings is an important principle of dressing change.

How to deal with the scar left by the wound?

If the scar on the body is caused by accident, if it is not carefully stitched at that time, it will not only affect the appearance, but also cause serious psychological burden. How to remove scars? Improvements can be made through the following points:

First, there are many scar-removing creams on the market, which are composed of some antibiotics, oils and some weak steroids. And has no definite effect on mature scars.

Second, if there are inflammatory symptoms around immature scars, you will get the effect of antibiotics, and if there is allergic inflammation, you will get the effect of steroids.

Thirdly, it is suggested to find a plastic surgeon for examination, and then make an appropriate diagnosis to see if it is necessary to use cosmetic thread to transform the wound, and then apply cosmetic paper glue, the effect will be better.

It is difficult to define the time of wound healing, and different parts are slightly different, which is probably the time when the assimilation and alienation of the wound itself reach a balance.

Generally speaking, it is usually completed around the third to fourth day. However, in clinic, if the suture is left for more than two weeks, there will be suture residue, so most of the sutures on hands and feet will be removed within ten days to two weeks, while those on scalp, abdomen, legs and arms will be removed within seven to ten days. Because the facial blood circulation is rich, the stitches can be removed within five days, so the time for the elderly or patients with poor health will of course be delayed.

Generally speaking, when the stitches are removed, the wound is only pulled by the fiber cells on both sides and does not heal. If you pull the wound to both sides with both hands, it will still split. About fourteen days later, the scar of the wound has formed. At this time, it still presents a red and hard appearance. It takes six weeks to soften, and most people's wounds will mature after one year. And more than 20% of the orientals, because of abnormal constitution, the scar of the wound is not mature, but has been proliferating, resulting in ugly scars. There are also some wounds, because of improper handling, random application of powder and liquid medicine, not only failed to clean the wound, but also caused wound pollution and delayed healing.

If the wound is complicated, such as an open fracture, it is much more complicated to handle. At ordinary times, it is necessary to remove necrotic tissue, remove bones that have lost blood circulation, and then change the medicine every day. Wait for a week or more, and then cover the wound with skin graft or skin flap after the wound infection is completely controlled. Of course, there are also some orthopedic surgeons who will fix the fracture at the right time, hoping to cure it in the shortest time. If the wounds in other parts go deep into the chest cavity, abdominal cavity and brain, the treatment of the wounds will be more complicated, which requires the careful operation of specialists and the care of intensive care unit. Western medicine has been introduced into China for nearly a hundred years. Because of China's long cultural background, people can't get rid of the influence of China's old ideas when receiving western medicine treatment, which further affects doctors' treatment habits. Take the treatment of wounds as an example. Local patients always ask if they want to change their dressing and get an injection. Some people even said, "doctor, please apply more medicine, and it will be soon." These are already the most important steps for every patient.

So, do you want to apply medicine to the wound? At present, in large hospitals, doctors only use optimal iodine solution and hydrogen peroxide as local bactericides for wounds, and only burns and scalds are special. Antibiotic ointment or mineral amine ointment containing silver ions is used to cover the wound to avoid infection. The familiar red syrup, yellow syrup and purple syrup have long been put on the shelf. Because the most important thing for wound healing is to rely on the regeneration and repair of its own fibroblasts. After proper debridement, it is more than enough for the defense system of human body to deal with general bacterial infection. Although topical medicinal water and ointment are effective, they will also hinder the survival of fibrous cell buds.

1974 In March, a paper entitled "Toxicity of topical drugs to cells and bacteria" was published at the Veterans Medical Center in Florida. Among them, the drugs tested are iodine solution, hydrogen peroxide solution, acetic acid and deacon solution commonly used in root canal treatment. Staphylococcus aureus was also used as the test bacteria, and fibroblasts from neonatal foreskin were cultured at the same time, and the toxicity of drugs to cells and bacteria was detected, and the experiment of control group was done.

It was found that at the usual concentration, except for acetic acid, which only killed 20% of the bacteria, all other chemicals killed 100% of the bacteria, and the effect was very good. However, all the potions also killed 100% of the fibroblasts. In additional experiments, it was shown that the best iodine solution diluted 1000 times and hydrogen peroxide diluted1000 times still had sufficient bactericidal ability, but they were not toxic to fiber bud cells. Therefore, the concentration of disinfectants currently used can be reduced to reduce the toxicity to cells; At the same time, for the wound that has been sutured, in theory, after two or three days, the epithelial cells have grown up and there is no need to rub medicine inside. Just for peace of mind.

Any wound will leave a scar. How is the scar formed? How can we avoid ugly scars? To understand this thorny problem, we should start with the wound.

The skin is seriously damaged, and the human body reacts to it immediately after the wound appears, and granular white blood cells and mononuclear white blood cells are immediately gathered near the wound, and the number ratio is about five to one; If there is bacterial infection, granular white blood cells will increase sharply. On the third day or so, granular white blood cells will begin to decompose and disappear, releasing albumin to digest and tidy up the wound, which is beneficial to the phagocytosis of mononuclear white blood cells. At the same time, monocytes are gradually increasing, and they release chemokines to meet more companions and stimulate the production of fibroblasts. At this time, the reconstruction of the organization began. Monocytes began to remove necrotic tissue from the wound, and at the same time, they also triggered angiogenesis. At the same time, fibroblasts produce a lot of collagen to repair damaged tissues. This stage is almost the sixth day, and you can already see a layer of milky epithelial tissue on the surface of the wound, which is attached to the wounds on both sides. When collagen fills the wound, scars begin to form. At this point, the doctor can start to remove the stitches while the scar continues to mature. The so-called maturity means that the collagen tissue is stretched, and at the same time it is stretched by the wounds on both sides and begins to arrange neatly.

If there is no interference in the process of maturation and the collagen is arranged neatly, then the scar we have is light and flat, with neat sides and no hypertrophy or protrusion. On the contrary, if the formation of collagen is disturbed and arranged irregularly, ugly hypertrophic scars or scars will appear. In the process of collagen formation and maturation, oxygen, iron ions, vitamin C and amino acids are most needed. Therefore, in order to avoid ugly scars, in addition to not making the wound inflamed, moderate exercise, supplementing food and nutrition, and avoiding smoking (vasoconstriction reduces oxygen consumption and vitamin C) are the best preventive methods.

Scar is composed of fiber bud cells and fiber cells. The more mature the scar, the less fertile the fibroblasts are; Generally speaking, a normal scar takes six months to mature. Scars or hypertrophic scars take two to four years to stabilize. Surgery on immature scars will stimulate the growth of fibroblasts. Therefore, further plastic surgery of scars can only be done after at least half a year of recovery. Stubborn scars take at least two years to develop.

At present, the most effective way to treat scars in clinic is to apply pressure directly when scars are just formed, except for surgical plastic surgery. Generally applicable are elastic beam sleeve, paper tape and silicone film.

Their principle is that it will change the blood supply, relax the collagen and arrange it neatly. Another method is to inject drugs to control the formation of collagen during scar formation. The general treatment is once every four weeks, and the effect may not appear until the second or third injection. The average number of injections takes about six to ten times.

In order to avoid ugly scars, it is most necessary to properly care and suture the wounds. It is usually wrong to ask the patient to let the wound heal itself without suturing. Suture can reduce the area of the wound and speed up the healing of the wound. Moreover, after the wound is sutured, the care of the wound is very simple, and there is almost no need to change medicine, take medicine or inject. Aren't you tired of saving the wound and changing the medicine every day? The most terrible thing is that it will leave ugly scars. People who love beauty should weigh the gains and losses between the two.

Scar has always been a problem that puzzles patients and doctors. Although it is a scar the size of a grain of rice, if it is located on the nose, it constitutes an obvious defect. However, scars as big as burns and other accidents, if located in the bent parts of elbows or knees, will constitute dysfunction. The above simple examples explain the main reasons why scars are disgusting.

There are many kinds of scars, too numerous to mention, and the clinical classification is divided into:

First, a good scar: refers to a flexible flat cable-like scar with a color close to normal skin color.

Second, the normal scar: refers to the scar slightly raised, and the color is darker than the normal skin color.

Third, hypertrophic scars: higher than normal scars, darker in color, and itchy and painful.

Scar: This has the characteristics of a tumor. Among them, fibroblasts are constantly dividing and aggressive, and will invade the normal skin next to them. It is shaped like a crab claw and black as brown, so it is not called swollen crab feet, and patients will feel extremely itchy. They usually appear on the shoulders (where BCG is inoculated) and chest.

The causes of scar formation are mainly caused by poor healing and physical factors; As we all know, the treatment of wounds must be within eight hours of prime time, but most people often think that small wounds don't need to be stitched, as long as the dressing is changed every day. This is a completely wrong concept. On the contrary, a well-treated wound usually does not need dressing change before stitches are removed.

In an unstitched wound, the fibroblasts that repair the wound must wait until some exudates and fibers fill the wound before they can play their role. Because of the long distance between the two ends of the unstitched wound, the number and time of fibroblasts are much longer than those of the stitched wound. At this time, the seeds of scars have been planted.

How can I put it? Usually, when the wound heals, the tension of fiber bud cells is greater than the normal tension of the tissues on both sides, so the wound can finally heal by it, but; When the wound heals, the fibroblasts turn into fibers and become scars, losing their contractility, so the tension of the tissues on both sides is greater than that of the scars, and the scars gradually widen and even bulge.

There are many treatments for scars, and the treatment methods are often determined according to the situation of scars. Traditional treatment methods are nothing more than excision and suture, such as zigzag plastic surgery, skin grafting, injection, compression and silicone treatment. , briefly described as follows:

As we have said before, fibroblasts will shrink the wound, and the tension of the wounds on both sides will increase after suture removal, and even make the scar bulge. Therefore, the most important thing for plastic surgeons is to eliminate the tension on both sides of the wound when sewing it. Therefore, it is necessary to hold the wounds on both sides with absorbable sutures on the inside of the wounds, that is, to sew two or three layers; At present, the most advanced suture can stay in the body for three months, which can almost make the scar mature without getting wider and wider.

At the same time, the healed wound often suffers from excessive tension due to the direction of the underlying muscles. At this time, the doctor will consider Z-shaped plastic surgery according to the direction of muscle movement, so that the scar can be transformed into a part of the direction and the tension can be reduced.

If the scar is too big, or there is a hypertrophic scar, the appearance is quite disgusting, and the symptoms of itching and pain often appear, which makes people feel troubled. Skin grafting is usually needed after excision. Although the appearance and texture are not as good as normal skin, the quality is much better than hypertrophic scar or scar.

After skin grafting, both new skin and scar need long-term compression to reduce the pressure brought by adjacent normal skin and make the scar mature as soon as possible; So are new wounds and scars. If the new scar begins to itch, hurt, or thicken gradually, at this time, doctors often suggest injecting hormones, about once a month, to alleviate its strange growth and function.

In recent years, due to more and more materials implanted into human body, many doctors and scientists frequently study implanting expanded silicon bags into human body, and then injecting normal saline regularly to get extra skin propped up in a short time, and then removing scars or lesions on the skin. This method is called tissue expansion. At present, it has been widely used, which can reduce many complicated operations and improve the postoperative appearance. This is also a new trick for scar plastic surgery.

Doctors don't advocate plastic surgery until the scar is immature. In recent years, it has been found that "sticking a silicone film on the scar" or applying ointment mixed with silicone oil can achieve the effect of making the scar mature as soon as possible, and even make the scar smooth, especially on the forehead and face. It seems that the work of plastic surgeons will be reduced again.

There is a sentence in the textbook: "Time is the best doctor with scars". Indeed, you can see the scars left when you were a child. When you grow up, they have become flat and the same color as your skin. Therefore, unfortunately, if there are scars, it is best to follow the doctor's advice, which can be improved and actively treated. If those who need complicated procedures can't improve, leave everything to the free doctor "time"!