Fire wounds

Types of projectiles : are bullets

– fragments of mines and bombs

– marbles

– arrow-shaped elements

– secondary projectiles (teeth, fragments of bones and other)

A fire wound has three zones:

І. Zone channel - shows by itself the defect of fabrics, that can contain of blood, fabrics, extraneous bodies. Direction of channel depends on position of head of injured and closeness of fabrics.

ІІ. A zone of primary necrosis is a wall channel, fabric of this area nonviable and subject to moving away during.

ІІІ. Zone of molecular concussion - has reverse or irreversible changes of fabrics. Changes in this area take place slowly and gradually, often there are cells of secondary necrosis. Determination of this zone is an almost unsolved task.

Action of shock wave

1. Dermahemia, rashes, point hemorrhages.

2. Appearance of bubbles is on a skin due to removing layer by layer of epidermis.

3. Violations of integrity of epithelium, blowing off a horny layer.

4. Breaks of skin and subject to fabrics : cellulose, muscles, development of pneumoderma.

5. Destruction to the skeleton.

Features of fire wounds of face :

1. A closeness of cerebrum and his frequent damages of different character and degree are in combination with the damages.

2. Concentrating on a person practically all (except haptic) kinds and sense-organs (sight, rumor, sense of smell, taste) and frequent them the united damage.

3. A direct closeness is to fabrics and organs of large vascular and nervous barrels the damage of that can result in heavy complications (bleeding, paralysis, thermoanaesthesia and other)

4. Initial departments of the respiratory (larynx, trachea) and digestive (overhead third of gullet) systems, the damages of that cause complication of different degree similarly.

5. Plenty of vascular nets (the massive bleeding).

6. Presence of mimic muscles (of gaping of wound).

7. A presence of teeth (is secondary projectiles, assistance to the origin of complications of the used for setting fire character, positive (support for fixative bottom jaw of constructions).

8. Presence of the well expressed cellulose, wide venous net, anastomoses of her with the vessels of eye sockets and sines of brain (development of meningitises, to the thrombosis of sines and other)

9. A wound of lateral departments of face (is a paralysis of mimic musculature, bar salivary).

10. Function of face.

11. Fabrics of face have high regenerator ability, firmness to the «local» infection, cicatrization with formation of scars, that contain the small amount of elements (rich innervation, considerable blood supply, high tension of cellular immunity).

12. Special feed, special supervision.

13. Necessity of the special construction to the gas-mask.

14. Damage of ears, cavity of mouth (of difficulty, sight in the commonunication of surrounding and orientations in space).

At the stowage of plan of treatment it follows to take into account:

1. Kind, character and amount of projectiles.

2. Localization, direction, character of channel.

3. Type of wound : blind, through, tangent and other

4. Volume and type of damage of separate fabrics and organs.

5. Correlation of wound is with adherent organs and fabrics of facial and cerebral parts of chairman.

6. Presence or absence of the combined or united damages.

7. Functional state of the systems.

8. State of patient.

Features of fire wound :

• Processing wounds at mouth area (of proceeding in the form of lips to the muscle mouth ( by the first guy-sutures to pick up thread continuity of red border (guy-sutures to connect the muscle of mouth ( guy-sutures on a skin and mucous membrane);

• At considerable defects company and adherent fabrics of cheek (to edge her edges for peripheries, connecting a skin and mucous membrane);

• At through damages that get to the cavity of mouth, breaks of cheek (begin with inseaming of mucous membrane from the side of cavity of mouth (to remember about a salivary channel);

• At the damage of parenchima glands (layer-by-layer sew glandular fabric, capsule of gland, cellulose and skin ( the mucous membrane of cheek (the pointed scalpel a rubber graduating student or tubular drainage (destroy prophylaxis of salivary)).

• At the wound of peripheral branches of ternate nerve (treatment of wound is in the conditions of the specialized center.

Tangent wounds belong to easy, for them characteristically there is a damage only of soft fabrics, gaping of wound. Diagnostics does not cause difficulties.

Blind wounds have an ingate only, in channel there is an extraneous body, that presents the danger of damage of large vessels, nerves, cerebrum, larynx (basis of origin of festering complications in remote terms. Diagnostics is conducted on the basis of complaints, data of anamnesis, objective research, roentgenologic research (as a rule in 2th projections, at extraneous bodies (of contrasting of channel or with a probe in a channel.

Through wounds have the entrance and initial opening, what anymore than entrance. After direction of channel wounds can be transversal, sagital and vertical.