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Wound as

wounds, tissue, occurs, blood, death, brought and healing

WOUND ( AS. wund. C)11G. wunta, (,er.

wound; 1x•obably connected with Guth. winnan. to suffer). An injury attended with a division of tissue produced by sudden mechanieal force. The skin may be broken, as in the ease of an open wound; o• it may he unbroken, and deep structures attacked, as in a subcutaneous wound. Wounds are termed penetrating, when they enter a cavity without emerging; perforating, when they enter and emerge from a cavity. All wounds are accompanied by some death of tissue. If great areas are contused or lacerated, death and destruction are great, and graver conditions arise. Wounds may be classified as aseptic, when they are not contaminated by poisonous in fection: and as when bacterial or other fermentative agents have been admitted, in which ease suppuration and sloughing ensue.

Among the local symptoms of wounds are im pairment of function, pain. bleeding, and shock.

of muscles may be the result of a wound. leaving a limb powerless, for example. Pain results from laceration of nerves, and may vary in character from a sharp twinge to a dull ache. The amount of hemorrhage depends upon the nature and size of the wound, and the number and size of blood vessels injured. For shock, see that title. A special danger in the case of a large wound is that. of ht-embolism. This condition occurs when fat-globules gain access to the blood and are carried about with the circulation to lodge in some organs and produce death.

Repair of wounds is the process by which the cells of the part replace lost tissue. The most economical method is by primary adhesion, or 'first intention.' This occurs when the parts can be brought together in close coaptation and the parts are aseptic. There may be few or no symptoms of inflammation. Pressure, suturing, or position may secure the coaptation necessary. If this be impossible, and the edges of the wound must be left apart or there is a large amount of tissue missing, healing by 'secondary intention' or granulation occurs. That is, new tissue grows up in the deepest part of the wound. appearing like a heap of granules, gradually filling up the gap, and finally the skin shoots across \\lien the granulations reach the surface. This process is wasteful of tissue and of the patient's strength, as suppuration occurs during its progress. After

surfaces of a wound have begun to granulate, they may bs brought together so that the granu lations fuse, and the gap is closed. This is called healing by 'third intention.' Subcutaneous wounds heal similarly, the exudations being absorbed, and if there be no bacterial infection the process is rapid. Healing under a blood clot or by 'scabbing' is also an economical method. T/I the case of a fracture o• wound of bone, a callus (or provisional deposit of new bone) oc curs. covering the ends of the fragments and cementing them together. Gradually part of this callus disappears, as 'knitting' is complete. Wounded arteries heal much like bone.

In the treatment of a wound the surgeon must first stop the hemorrhage, by ligature, pressure, torsion of arteries, or the application of heat. The wound must then be cleansed and disinfected. all dead o• dying tissue, blood. and foreign bodies being removed. The lips of the wound must then be brought together as far as possible, and kept in place by suture or by adhesive plaster. Drainage must be secured, by the use of a tube, a piece of gauze, a hunch of horsehair, or other device, if the wound cannot lie closed. An aseptic dressing must then be applied. This may be of wool, cotton. gauze, jute, etc.. carladized, sublimated, or treated with boric acid, thymol, iodoform, or other disinfectant. Dressings must be changed and removed occasionally.

Poisoned wounds may be the results of ilia microbial infection of glanders, anthrax, rabies, actinuun•cosis, etc. (qq.v.), or may lie due to chemical agents. Dissection NviMildA :ur septic wounds generally of great virulence, contracted during post-mortem examinations or the dis seet ion of dead bodies. They are due to microbic poisoning. In many poisoned wounds :imputa tion is early necessary, or free incisions to favor supinu•atinu and sloughing oil of tiro attacked tis sue. Meanwhile internal supportive treatment is necessary. Sep Gins:stun. WorND.

Consult: Morris, //ow We Treat Wounds 7o Day (New York, 1886) ; Keen and White, Textbook of Surgery (Philadelphia, 1SY9) ; Robb, „Iscptical Surgical Technique (ib., 1902).