Cause
Soft-tissue injuries are often caused by falls, direct or indirect violence. Soft tissue injuries often occur in sports injuries as well. Serious soft tissue injuries can occur in traffic accidents or falls from great heights.
Diagnostics
During diagnostics, a thorough examination (inspection) of the wound is important so that nothing is overlooked. Attention should be paid to reddening, swelling, bleeding, bruising, overheating, color, odor and any fluid leaking from the wound. Redness, swelling, overheating, pain, functional impairment are so-called signs of inflammation.
A physical examination with orthopedic examination techniques is also important in order not to overlook joint injuries, bleeding and other accompanying injuries. Imaging diagnostic methods are also important to determine the severity and localization of fractures and injuries. Care should be taken before direct MRI diagnostics, as metallic foreign bodies attract to the MRI machine, which can lead to further serious injuries and complications.
Although MRI diagnostics is very informative in the case of complicated soft tissue injuries, metallic foreign bodies should be excluded beforehand. In addition, MRI diagnosis is expensive in contrast to alternative X-ray and CT imaging. Whereby X-rays and CTs have the disadvantage of radiation exposure and a less accurate soft tissue assessment takes place in contrast to MRI.
Therefore, after careful consideration, a decision should be made in favor of a meaningful imaging if necessary. Depending on the extent of the injury, conservative and/or surgical steps must be taken. Conservative measuresIn no case should deep-seated foreign bodies be removed manually from surrounding vessels and nerves without precise knowledge as a first measure.These foreign bodies are later surgically removed.
Initial measures, on the other hand, include Further measures then include classic wound care with wound cleaning, irrigation, disinfection, ointments and sterile dressings with gauze bandages. With ointments, a distinction is made between ointments for wounds that are too dry and ointments for wounds that are too moist. The dressing should also be changed to match the injury.
The first change of dressing after an operation takes place at the earliest 48 hours after the operation if the dressing is not perfused with blood. In the case of conservative measures, splints and plasters may also be used for immobilization and pain relief. This can be essential for wound healing.
Nevertheless, it is important to pay attention to a possible small-step movement of the joints, as otherwise muscle and tendon shrinkage can occur. Conservative therapy also includes checking the tetanus vaccination status, which should definitely be refreshed, especially in the case of soft tissue injuries. The prophylactic vaccination is given 5-12 hours after the injury.
Tetanus prophylaxis is used in the case of large wounds or if the vaccination has been refreshed a long time ago. In some cases, prophylactic antibiotics may also be used for large wounds. This should always be assessed according to the severity of the injury and the contamination of the wound.
However, therapeutic antibiotics may also be administered if the soft tissue injury becomes inflamed. In case of pain, painkillers and anti-inflammatory drugs should be administered. In the case of very severe pain or extremely large wounds, local anaesthesia or the induction of anaesthesia can also be helpful.
Surgical measuresDependent on the type of injury, it may first be necessary to perform surgical cleaning of the wound. Foreign bodies should also be surgically removed after appropriate diagnostics and localization of foreign bodies. Direct ligation of vessels to stop bleeding may also be necessary.
In the case of septic wounds (i.e. wounds that are already inflamed), either a careful excision of the wound or a so-called wound toilet, in which a thorough removal of dead tissue is carried out after cleaning the wound. Depending on the injury, the therapy of tendon, muscle and ligament injuries may involve the use of direct sutures, refixation to the bone (here there are various suture threads, anchors, drill holes for the anchors or indirect sutures) but also, in the case of complicated reconstructions, the removal of tissue from other parts of the body and reinsertion at the affected region. Vascular and nerve injuries must also be treated with sutures and reconstructions.
There are various possibilities of application for wound closure: There is the simple approximation of the wound edges with plaster strips. Other alternatives include gluing, stapling or even suturing using various techniques depending on the soft tissue affected.
- A temporary first hemostasis by impression
- A drug-based pain relief
- Immobilization of the joints through splints
