Soft tissue injuries

The soft tissue injury can be detected, for example, in MRI.

definition

A soft tissue injury is a traumatic injury. Soft tissues include bone-protecting and surrounding tissues such as muscles, tendons, ligaments, skin, subcutaneous tissue, adipose tissue, including vascular and nerve tissues. Statistically the most common are injuries of the Achilles tendon, patellar tendon or biceps tendon.

In the case of soft tissue injuries, a distinction is made between open and closed injuries. If uninjured skin is above the injury, it is a closed wound. If, on the other hand, there has already been an injury to the skin, it is an open injury.

Classification according to Tscherne and Oestern

To better assess the extent of the injury, they designed a classification of soft tissue injury that distinguishes open and closed injury.

Open soft tissue injury
The open soft tissue injury can be divided into four degrees:

  • Grade 1: Grade 1 is a puncture of the skin from the inside to the outside.
  • Grade 2: Grade 2 is a major soft tissue injury, with internal to external trauma. Here, the risk of ignition is increased.
  • Grade 3: Grade 3 is an exposed fracture with additional injury to vessels and nerves.
  • Grade 4: amputation injury

Closed soft tissue injury
The difficulty with closed soft tissue injuries is that one can easily overlook serious injuries or the extent of the injury is initially unclear.

  • Grade 0: simple fracture injury, no or hardly any soft tissue injury due to indirect influence of force
  • Grade 1: simple to moderate fracture injury with superficial skin injury or bruising by bone fragments
  • Grade 2: moderate to severe fracture of the fracture, a deep, often contaminated wound with abrasion of the skin, contusion due to the direct influence of force and a dreaded compartment syndrome (in the compartment syndrome there is an increase in pressure in the tissue, for example due to a bleeding into the tissue) it leads to a squeezing of the vessels and nerves and thereby to a circulatory disorder and death of the tissue.)
  • Grade 3: Severe fracture injury with high skin crushing and / or muscle damage, ablation wounds (decollement: upper skin layers are separated from deeper soft tissue layers by tangential force effects), compartment syndrome (see above) and vascular injuries

reason

Soft tissue injuries often result from falls, direct or indirect trauma. Often it comes to sports injuries to soft tissue injuries. In the case of traffic accidents or falls from high altitude, severe soft tissue injuries can occur.

diagnostics

In diagnostics, a thorough inspection ( inspection ) of the wound is important in order not to miss anything. Attention should be paid to redness, swelling, bleeding, bruising, overheating, color, odor, and the discharge of fluid from the wound. Redness, swelling, overheating, pain, functional limitations are so-called signs of inflammation.
Also a physical examination with orthopedic examination techniques are important to not overlook joint injuries, hemorrhages, and other accompanying injuries.

In addition, diagnostic imaging methods are important to determine the severity and localization of fractures and injuries. One should beware of direct MRI diagnostics, as metallic foreign bodies may attract MRI equipment, which can lead to further serious injuries and complications. Although MRI diagnostics for complicated soft tissue injuries is very enlightening, but as I said before metallic foreign body should be excluded before. In addition, MRI diagnostics is expensive compared to alternative X-ray and CT scans. Where X-ray and CT bring the disadvantage of radiation exposure and less accurate soft tissue assessment as opposed to MRI takes place. Thus, one should decide after careful consideration if necessary for a meaningful imaging.

therapy

Depending on the degree of injury, a soft tissue injury can be treated conservatively or surgically. For example, surgery offers the possibility of intensive wound cleansing.

Depending on the extent of the injury, one must initiate conservative and / or operative steps.

Conservative measures
By no means should you first remove deep foreign bodies without proper knowledge of surrounding vessels and nerves. These foreign bodies will later be surgically removed. On the other hand, the first measures include:

  • a temporary first hemostasis by pressing
  • a medical pain relief
  • Immobilization of the joints by splints

Further measures then include a classic wound care with wound cleansing, rinsing, disinfection, ointments and sterile bandages by gauze bandages. With the ointments one differentiates depending upon ointments for too dry wounds or ointments for too humid wounds.
Also should be a violation of appropriate dressing change. The first dressing change after surgery is at least 48 hours after, if the dressing is not bled.

Conservative measures may also involve the use of splints and plasters for immobilization and pain relief. This can be essential for wound healing. Nevertheless, one should attach importance to a possible small-step movement of the joints, otherwise it can lead to muscle and tendon shrinkage.
Conservative therapy also includes the review of tetanus vaccine status, which should be refreshed, especially in cases of soft tissue injury. The prophylactic vaccination takes place 5-12 hours after the injury. Tetanus prophylaxis is used for large wounds or long-term vaccine replenishment.

In some cases, the use of prophylactic antibiotics may also occur in large wounds. This should always be judged according to the severity of the injury and the contamination of the wound. But it may also come to a therapeutic antibiotics, if it comes to an inflammation of the soft tissue injury. For pain, analgesics and anti-inflammatories should be given. For very severe pain or extremely large wounds, local anesthesia or induction of anesthesia may be helpful.

Operational measures
Depending on the type of injury, it may be necessary to carry out surgical cleaning of the wound. Also, after proper diagnosis and localization of foreign bodies, foreign bodies should be surgically removed. In addition, a direct ligature of vessels for hemostasis may be needed.
In septic wounds (ie wounds that are already inflamed), you must either perform a careful wound excision or a so-called wound toilet, in which after cleaning the wound a thorough removal of dead tissue is carried out.

Depending on the injury, it can be used for the treatment of tendon, muscle and ligament injuries for the application of direct sutures, bone fixation (there are various sutures, anchors, drill holes for the anchors or indirect sutures) but also in complicated reconstructions for removal of Tissues come from other body region and re-insert at the affected area. Vascular and nerve injuries must also be treated with sutures and reconstructions.

For wound closure, there are various possibilities of application: There is the simple approach of the wound edges by plaster strips. Other alternatives include gluing, stapling or sewing in various techniques depending on the affected soft tissue.

forecast

The prognosis of soft tissue injury depends on several factors. On the one hand, whether it is a direct or indirect act of violence, the severity of injury and infection by pollution are important factors in the prognosis.

The prognosis is also dependent on the injured body region. In abdominal, thoracic and pelvic injuries, severe internal bleeding can occur.

Not to be underestimated is also the other general condition of the patient, if, for example, other illnesses are present. Particularly at risk are patients with immune disease, diabetes and tumors.

Soft Tissue Injuries (February 2020).


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