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Musculoskeletal problems and injuries - part 8

Vết thương tiếp tục phải trải qua tu sửa 18 đến 24 tháng, trong đó thời gian tổng hợp collagen tiếp tục và rút lại xảy ra. Thông thường trong thời gian này, vết sẹo trở nên mềm hơn và ít bị chú ý. Các màu sắc nổi bật của sẹo dần dần mất dần, kết quả trong một màu sắc phù hợp với vùng da xung quanh. | 11. Care of Acute Lacerations 235 Phase Three Maturation Remodeling Phase The wound continues to undergo remodeling for 18 to 24 months during which time collagen synthesis continues and retraction occurs. Normally during this time the scar becomes softer and less conspicuous. The prominent color of the scar gradually fades resulting in a hue consistent with the surrounding skin. Aberrations of the maturation process can result in an unsightly scar such as a keloid. Such scars are due to a combination of inherited tendencies and extrinsic factors of the wound. Proper technique in wound care and repair minimizes the extrinsic contribution to keloid formation. If it is necessary to revise an unsightly scar the ideal delay is 18 months or more after the initial repair. Anesthesia Under most circumstances it is preferable to anesthetize the wound prior to preparation for closure. Before applying anesthesia the wound is inspected using a slow gentle aseptic technique to ascertain the extent of injury including an assessment of the neurovascular supply. At this time a decision is made to refer the patient if the complexity of the wound warrants consultation. Topical Agents When appropriate topical anesthesia is ideal as pain can be relieved without causing more discomfort or anxiety. Small lacerations may be closed without additional medications. PAC Pontocaine Adrenaline Cocaine and TAC Tetracaine Adrenaline Cocaine Pontocaine or tetracaine 2 aqueous epinephrine adrenaline 1 1000 cocaine PAC is the most commonly used topical agent.3 4 It may be prepared in a 100-mL volume by mixing 25 mL of 2 tetracaine 50 mL of 1 1000 aqueous epinephrine 11.8 g of cocaine and sterile normal saline to a volume of 100 mL. Placing a saturated pledget over the wound for 5 to 15 minutes often provides adequate local anesthesia. Blanching of the skin beyond the margin of the wound allows an estimation of adequate anesthesia. Further anesthesia may be applied by injection if necessary. 236 .