32. SOFT TISSUE TRAUMA

what are contusions?

'closed' injuries

bruises

there is no laceration of the skin or the mucosa

what is the etiology of contusions?

blunt force

what are the clinical signs of contusions?

1. ecchymosis

2. haematoma

3. swelling

4. pain

what are ecchymosis?

blue/red spots or swellings

the blood leaks out of blood vessels

occur very quickly

what are haematomas?

lots of blood leaks out of vessels

initially they are dark red

as blood breaks down they change in colour

where is swelling more common?

it is more common when tissues have more loose connective tissue (like the infraorbital space and the buccal spaces)

how do we diagnose contusions?

history (trauma)

clinical signs

what is the differential diagnosis?

haematoma can be mistaken for

- subperiosteal fracture

- traumatic aneurysm

how do we treat contusions?

ice packs- for 20-30min periods over 24 hours

heat packs after 48h

drainage of the haematoma if it doesn't resorb after 7-10d

what are wounds?

open injuries

disruptions in the skin or mucous membrane's lining

what are the types of wounds according to the type of injury?

incised and slashed wounds

penetrated and puncture wounds

lacerated wounds

contused lacerated wounds

gunshot injuries

bite wounds

what are the clinical signs of wounds?

pain

gaping- depends on the shape and size (when the injury is perpendicular to linger lines, the wound gapes more)

bleeding- depends on the blood vessels affected

what are the features of incised wounds?

smooth borders

sharp angles

linear

gaping and profuse bleeding

what are the features of penetrating/puncture wounds?

appear small from the outside but are deeper

can damage large vessels so cause lethal bleeding

the object can leave a track so obstructs drainage of exudate

what are the features of lacerated wounds?

irregular shape

uneven margins

no profuse bleeding

due to excessive mechanical force

what are the features of contused lacerated wounds?

this is a combination of a bruise (contusion) and laceration

they have linear or squashed margins

they can have variable depth

the contusions are blue colour

necrotic borders

what are the features of bite wounds?

bite wounds can be from- insects, snakes, dogs, horses, humans

they have lacerate/crushed borders

lots of haemorrhage areas

they are a high contamination risk

what are the features of gunshot wounds?

2 main wounds- entry and exit

risk of damage to major blood vessels

3 main areas of the wounds

1. area of destruction

2. area of irreversible damage

3. area of molecular concussion

how are wounds diagnosed?

based on their clinical appearance and the history of the patient

what is the differential diagnosis for wounds?

mistaken for open fractures

what is the treatment?

deep wounds- these are in subdermal fat tissue and muscles

- anaesthesia

- irrigation

- suturing

superficial wounds

- anaesthesia

- irrigation

- can heal by secondary intention