How to properly care for a puncture wound. What are the signs of infection to watch for. When should antibiotics be used for puncture wounds. How long does it typically take for a puncture wound to heal completely.

Understanding Puncture Wounds: Types, Causes, and Initial Assessment

Puncture wounds are distinctive injuries that penetrate the skin, often caused by sharp, pointed objects. Unlike cuts or lacerations, these wounds tend to be narrow and deep, potentially affecting underlying tissues and structures. Common causes include nails, needles, teeth, and other sharp implements.

When assessing a puncture wound, it’s crucial to consider the following factors:

• Depth of penetration
• Location on the body
• Object that caused the wound
• Potential for contamination
• Tetanus immunization status of the injured person

Is immediate medical attention always necessary for puncture wounds? While minor punctures can often be treated at home, certain situations warrant professional medical care. Seek medical attention if the wound is deep, caused by a dirty or rusty object, or if there’s persistent bleeding or signs of infection.

Immediate Care: First Aid for Puncture Wounds

Proper first aid is crucial for preventing complications and promoting healing. Here are the essential steps to follow:

1. Clean hands thoroughly before treating the wound
2. Apply gentle pressure to stop any bleeding
3. Wash the wound with clean water and mild soap
4. Remove any visible debris, but avoid probing deeply
5. Apply an antibiotic ointment if available
6. Cover the wound with a sterile bandage

Should you remove an object embedded in a puncture wound? It’s generally advisable to leave deeply embedded objects in place and seek immediate medical attention. Removing such objects can cause further tissue damage and increased bleeding.

Tetanus Prevention

Tetanus is a serious concern with puncture wounds. Ensure your tetanus vaccination is up to date. If uncertain, consult a healthcare provider about receiving a booster shot, especially if the wound is deep or contaminated.

Proper Wound Care: Promoting Healing and Preventing Infection

Ongoing care is crucial for puncture wound healing. Follow these guidelines:

• Keep the wound dry for the first 24-48 hours
• After initial healing, clean the wound daily with mild soap and water
• Apply a thin layer of petroleum jelly to keep the wound moist
• Change the bandage daily or when it becomes wet or dirty
• Avoid using hydrogen peroxide or alcohol, which can impede healing
• Elevate the affected area to reduce swelling

How often should you change the dressing on a puncture wound? Generally, change the dressing daily or more frequently if it becomes wet or soiled. This helps maintain a clean environment for healing and allows you to monitor the wound’s progress.

Recognizing and Addressing Infection: Key Signs and Symptoms

Puncture wounds are particularly prone to infection due to their depth and potential for harboring bacteria. Be vigilant for these signs of infection:

• Increased pain or tenderness around the wound
• Redness or warmth spreading from the injury site
• Swelling or hardening of the surrounding area
• Pus or cloudy fluid draining from the wound
• Red streaks extending from the wound
• Fever or chills
• Swollen lymph nodes near the injury

Are all puncture wounds at equal risk for infection? No, certain factors increase infection risk, including deep wounds, those caused by dirty objects, wounds on the feet or hands, and injuries in individuals with compromised immune systems or diabetes.

When to Seek Medical Attention

Don’t hesitate to consult a healthcare provider if you observe any signs of infection or if the wound isn’t healing properly. Prompt treatment can prevent serious complications.

Antibiotic Use in Puncture Wound Treatment: Necessity and Considerations

Antibiotics aren’t always necessary for puncture wounds but may be prescribed in certain situations:

• Deep or extensively contaminated wounds
• Animal or human bites
• Wounds in high-risk areas (e.g., hands, feet)
• Presence of foreign bodies in the wound
• Signs of developing infection
• Patients with weakened immune systems or chronic conditions

How do healthcare providers determine if antibiotics are necessary? The decision is based on factors such as the wound’s characteristics, the patient’s overall health, and the presence of infection signs. When prescribed, it’s crucial to complete the full course of antibiotics as directed.

Types of Antibiotics Used

Common antibiotics for puncture wound infections include:

• Amoxicillin-clavulanate
• Cephalexin
• Doxycycline
• Trimethoprim-sulfamethoxazole

The specific antibiotic chosen depends on factors such as the likely causative bacteria and patient allergies.

Healing Process and Timeline: What to Expect

The healing time for puncture wounds varies depending on several factors:

• Depth and location of the wound
• Overall health of the individual
• Proper wound care and hygiene
• Presence or absence of infection
• Any underlying health conditions

What are the stages of puncture wound healing? The healing process typically involves four main stages:

1. Hemostasis (blood clotting)
2. Inflammation (cleaning the wound)
3. Proliferation (new tissue formation)
4. Remodeling (strengthening of new tissue)

Minor puncture wounds may heal within a few days to a week. Deeper wounds or those complicated by infection may take several weeks or longer to heal completely.

Factors Affecting Healing Time

Several factors can influence the healing process:

• Age and overall health
• Nutritional status
• Smoking habits
• Proper wound care
• Presence of chronic conditions like diabetes

Complications of Puncture Wounds: Potential Risks and Prevention

While many puncture wounds heal without incident, potential complications can occur:

• Infections (including cellulitis and abscess formation)
• Tetanus
• Retained foreign bodies
• Damage to underlying structures (nerves, tendons, blood vessels)
• Scarring
• Chronic pain or numbness

How can you minimize the risk of complications from puncture wounds? Proper initial care, thorough cleaning, appropriate use of antibiotics when indicated, and vigilant monitoring for signs of infection are key strategies for preventing complications.

Special Considerations for High-Risk Wounds

Certain types of puncture wounds require special attention:

• Animal bites (risk of rabies and specific bacterial infections)
• Human bites (high risk of infection)
• Punctures through shoe soles (risk of Pseudomonas infection)
• Wounds near joints or tendons

These injuries often warrant immediate medical evaluation and may require specialized treatment approaches.

Long-Term Care and Follow-Up: Ensuring Complete Recovery

After the initial healing phase, ongoing care is important for optimal recovery:

• Monitor the wound site for any changes or signs of delayed healing
• Protect the area from re-injury during activities
• Maintain good overall health to support healing
• Follow up with healthcare providers as recommended
• Consider scar management techniques if necessary

When can normal activities be resumed after a puncture wound? The timeline varies depending on the wound’s severity and location. Generally, light activities can be resumed once pain subsides and the wound shows signs of healing. Consult your healthcare provider for personalized advice on returning to specific activities.

Scar Management

While puncture wounds often heal with minimal scarring, larger or more complex injuries may result in noticeable scars. Scar management techniques include:

• Silicone sheets or gels
• Massage therapy
• Sunscreen application to prevent discoloration
• Topical treatments (e.g., vitamin E, onion extract)

Consult a dermatologist or wound care specialist for advice on managing significant scarring.

By understanding the nature of puncture wounds, providing proper initial care, and diligently following through with ongoing treatment and monitoring, most individuals can expect successful healing and minimal complications. Remember that each wound is unique, and when in doubt, seeking professional medical advice is always the safest course of action.

Puncture Wounds: Care Instructions | Kaiser Permanente

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Overview

A puncture wound can happen anywhere on your body. These wounds tend to be narrower and deeper than cuts.

A puncture wound is usually left open instead of being closed. This is because a puncture wound can be easily infected, and closing it can make infection even more likely.

You will probably have a bandage over the wound.

The doctor has checked you carefully, but problems can develop later. If you notice any problems or new symptoms, get medical treatment right away.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

• Keep the wound dry for the first 24 to 48 hours. After this, you can shower if your doctor okays it. Pat the wound dry.
• Don’t soak the wound, such as in a bathtub. Your doctor will tell you when it’s safe to get the wound wet.
• If your doctor told you how to care for your wound, follow your doctor’s instructions. If you did not get instructions, follow this general advice:
  • After the first 24 to 48 hours, wash the wound with clean water 2 times a day. Don’t use hydrogen peroxide or alcohol, which can slow healing.
  • You may cover the wound with a thin layer of petroleum jelly, such as Vaseline, and a nonstick bandage.
  • Apply more petroleum jelly and replace the bandage as needed.
• Prop up the sore area on pillows anytime you sit or lie down during the next 3 days. Try to keep it above the level of your heart. This helps reduce swelling.
• Avoid any activity that could cause your wound to get worse.
• Be safe with medicines. Read and follow all instructions on the label.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

When should you call for help?

Call your doctor now or seek immediate medical care if:

• You have new pain, or your pain gets worse.
• The wound starts to bleed, and blood soaks through the bandage. Oozing small amounts of blood is normal.
• The skin near the wound is cold or pale or changes color.
• You have tingling, weakness, or numbness near the wound.
• You have trouble moving the area near the wound.
• You have symptoms of infection, such as:
  • Increased pain, swelling, warmth, or redness around the wound.
  • Red streaks leading from the wound.
  • Pus draining from the wound.
  • A fever.

Watch closely for changes in your health, and be sure to contact your doctor if:

• The cut reopens.
• You do not get better as expected.

Where can you learn more?

Go to https://www. healthwise.net/patientEd

Enter S876 in the search box to learn more about “Puncture Wounds: Care Instructions”.

Cuts and puncture wounds Information | Mount Sinai

Wound – cut or puncture; Open wound; Laceration; Puncture wound

A cut is a break or opening in the skin. It is also called a laceration. A cut may be deep, smooth, or jagged. It may be near the surface of the skin, or deeper. A deep cut can affect tendons, muscles, ligaments, nerves, blood vessels, or bone.

A puncture is a wound made by a pointed object such as a nail, knife, or sharp tooth. Puncture wounds often appear to be on the surface, but may extend into the deeper tissue layers.

The essentials of a good first aid kit include a variety of bandages, medications, and equipment to stabilize injuries until proper medical attention can be administered.

A laceration is a wound that is produced by the tearing of soft body tissue. This type of wound is often irregular and jagged. A laceration wound is often contaminated with bacteria and debris from whatever object caused the cut. A puncture wound is usually caused by a sharp pointy object such as a nail, animal teeth, or a tack. This type of wound usually does not bleed excessively and can appear to close up. Puncture wounds are also prone to infection and should be treated appropriately.

Stitches are primarily used if the cut is more that a quarter inch deep, is on the face, or reaches bone. Stitches help hold the wound together so it can heal properly. Stitches are removed between 3 to 14 days after they are put depending upon which area of the body was injured. Stitches on the face can be removed within 3 to 5 days but areas of high stress such as hands, elbows, and knees must stay in 10 to 14 days.

Venomous snake bites are medical emergencies and require immediate attention. A venomous snake bite can cause severe local tissue damage and often requires follow-up care. The right anti-venom can save a person’s life. Even though most snakes are not venomous, avoid picking up or playing with any snake unless you have been properly trained.

To treat a minor cut at home first wash your hands thoroughly with soap to avoid infection. Next wash the cut with mild soap and water.

Symptoms

Symptoms include:

• Bleeding
• Problems with function (movement) or feeling (numbness, tingling) below the wound site
• Pain

Infection may occur with some cuts and puncture wounds. The following are more likely to become infected:

• Bites
• Punctures
• Crush injuries
• Dirty wounds
• Wounds on the feet
• Wounds that are not promptly treated

First Aid

If the wound is bleeding severely, call your local emergency number, such as 911.

Minor cuts and puncture wounds can be treated at home. Prompt first aid can help prevent infection and thereby speed healing and reduce the amount of scarring.

Take the following steps:

FOR MINOR CUTS

• Wash your hands with soap or antibacterial cleanser to prevent infection.
• Then, wash the cut thoroughly with mild soap and water.
• Use direct pressure to stop the bleeding.
• Apply antibacterial ointment and a clean bandage that will not stick to the wound.

FOR MINOR PUNCTURES

• Wash your hands with soap or antibacterial cleanser to prevent infection.
• Rinse the puncture for 5 minutes under running water. Then wash with soap.
• Look (but do not poke around) for objects inside the wound. If found, don’t remove them. Go to your emergency or urgent care center.
• If you can’t see anything inside the wound, but a piece of the object that caused the injury is missing, also seek medical attention.
• Apply antibacterial ointment and a clean bandage that will not stick to the wound.

Do Not

• DO NOT assume that a minor wound is clean because you can’t see dirt or debris inside. Always wash it.
• DO NOT breathe on an open wound.
• DO NOT try to clean a major wound, especially after the bleeding is under control.
• DO NOT remove a long or deeply stuck object. Seek medical attention.
• DO NOT push or pick debris from a wound. Seek medical attention.
• DO NOT push body parts back in. Cover them with clean material until medical help arrives.

When to Contact a Medical Professional

Call 911 or your local emergency number if:

• The bleeding is severe or cannot be stopped (for example, after 10 minutes of pressure).
• The person cannot feel the injured area, or it doesn’t work right.
• The person is otherwise seriously injured.

Call your health care provider right away if:

• The wound is large or deep, even if the bleeding is not severe.
• The wound is more than a quarter inch (.64 centimeter) deep, on the face, or reaching the bone. Stitches may be needed.
• The person has been bitten by a human or animal.
• A cut or puncture is caused by a fishhook or rusty object.
• You step on a nail or other similar object.
• An object or debris is stuck. Do not remove it yourself.
• The wound shows signs of infection such as warmth and redness in the area, a painful or throbbing sensation, fever, swelling, a red streak extending from the wound, or pus-like drainage.
• You have not had a tetanus shot within the last 10 years.

Prevention

Keep knives, scissors, sharp objects, firearms, and fragile items out of the reach of children. When children are old enough, teach them to how to use knives, scissors, and other tools safely.

Make sure you and your child are up to date on vaccinations. A tetanus vaccine is generally recommended every 10 years.

Ball JW, Dains JE, Flynn JA, Solomom BS, Stewart RW. Skin, hair, and nails. In: Ball JW, Dains JE, Flynn JA, Solomom BS, Stewart RW, eds. Seidel’s Guide to Physical Examination. 9th ed. . St Louis, MO: Elsevier; 2019:chap 9.

Lammers RL, Aldy KN. Principles of wound management. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 34.

Simon BC, Hern HG. Wound management principles. In: Walls RM, Hockberger RS, Gausche-Hill M, eds, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 52.

Last reviewed on: 11/13/2021

Reviewed by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Wounds with infection (purulent): treatment, treatment, ointments

It is dangerous when even a small wound becomes infected with pathogens. Doctors call this situation wound infection . Infection of tissues can create problems not only at the site of the damage itself, but, unfortunately, have serious consequences for the entire body as a whole.

Household injuries and cuts are a high risk group for infection with pathogens ¹ . At first it may seem that a small damaged area will not cause problems. But with improper and untimely processing, conditions are created for the infection to join. Therefore, as a rule, such complications arise when the rules for caring for wounds and surgical sutures are not followed. It is important to remember that the presence of other chronic infectious processes can increase the risk of complications ¹ .

In total, doctors identify several key factors that complicate wound healing and contribute to infection ¹

• The number of copies of microbes that simultaneously entered the wound (doctors call it microbial contamination).
• Reduced protective properties of the body, for example, due to hypothermia or the presence of chronic diseases (eg diabetes, radiation sickness).
• Impaired circulation in an injured part of the body (for example, when applying a hemostatic tourniquet).
• Traumatic conditions, such as traumatic shock or massive blood loss.
• Large wound, presence of remnants of foreign bodies.

Symptoms of infection in the wound

The main symptoms of infection are redness, swelling, soreness, increased temperature of soft tissues in the area of ​​the wound and injury.

Reproduction of pathogenic bacteria in the wound forms an immediate inflammatory response. The more serious the problem, the more the body tries to protect itself from it. Therefore, the reaction can develop over a larger area than the site of the wound and damage. All this is accompanied by symptoms of general intoxication: fever, nausea, chills, weakness .

It should be remembered that the body’s acute response to a pathogen does not always proceed in the same way. Next, we highlight the key dangerous microbes, in relation to which the body reacts in each case quite specifically:

With staphylococcal infection – the edges of the wound begin to die off intensively (tissue necrosis). Pus in this case is a thick, creamy consistency.

The first signs of purulent inflammation occur 2-3 days after surgery or injury. If the patient receives antibiotic therapy, the first symptoms may occur after 4-6 days.

Important! After getting injured outside the home, it’s best to play it safe and get a tetanus toxoid vaccine. Unfortunately, advanced form of tetanus in 40-45% of cases is associated with a lethal outcome ³ .

Further, the purulent process has several stages of progression. Over time, an abscess is formed – a purulent focus, delimited by a capsule of connective tissue. The formation of an abscess prevents the spread of infection to healthy tissues and the entry of pathogens into the bloodstream.

Phlegmon , or a diffuse purulent-inflammatory process, spreads through loose cellular spaces beyond the wound. When the pathogen enters the bloodstream, bacteremia and sepsis develop (general infectious infection of the body).

Wound infection complication if ignored

Bacteremia

Bacteremia is a condition in which bacteria enter sterile blood. The danger lies in the fact that they circulate in the bloodstream, which is a further factor in the spread of infection throughout the body. In such situations, endocarditis (inflammation of the inner lining of the heart), osteomyelitis (purulent-necrotic bone process) and other dangerous diseases that threaten the patient’s life.

Sepsis

Sepsis (Greek for “putrefaction”) is a systemic inflammatory reaction in response to the entry of microorganisms into the bloodstream. In this case, a large number of microbes enter the blood or the microbes are extremely aggressive in nature.

Systemic inflammatory response syndrome (SIRS) is confirmed by the presence of two or more signs ² :

• body temperature is more than 38°C or less than 36°C
• heart rate is more than 90 beats per minute
• respiratory rate is more than 20 per minute or hyperventilation is present (occurs when intensive breathing and causes a decrease in carbon dioxide in the blood)
• leukocytosis (increase in the number of leukocytes) more than 12*10 ⁹ /l or leukopenia (decrease in the number of leukocytes) less than 4*10 ⁹ /l, or the presence of immature forms of leukocytes more than 10%

Diagnosis of sepsis is established by the presence of a focus of infection and two or more signs of SIRS.

Severe sepsis is diagnosed in the presence of sepsis and multiple organ failure.

Septic shock is a variant of septic reaction, which is based on serious disorders of blood circulation, metabolism and pathological changes in cells. The patient is immediately admitted to the intensive care unit!

Local complications of wound infection:

Acute

purulent edema, phlegmon

Chronic

ni, bacterial gangrene, osteomyelitis

Local complications of wound infection can occur both independently and in the result of treatment. For example, purulent flow is formed at some distance from the original source of infection due to a violation of the outflow of pus from the wound as a result of blockage of drains or “blind” suturing of the wound.

Treatment of a wound with infection

In the treatment of infected wounds, adequate debridement is performed ³ . Traditionally, antiseptic solutions are used for this purpose: methylene blue, a solution of furacilin, iodine, hydrogen peroxide. These medicines stop the growth and reproduction of bacteria ^4.5 . However, a 3% hydrogen peroxide solution only temporarily reduces the number of microorganisms, and may also impede wound healing ⁶ . modern antiseptics , such as povidone-iodine ( Betadine ^® ) have the necessary disinfecting effect.

Betadine® (povidone-iodine) for the treatment of wound infections

Povidone-iodine is active against gram-positive and gram-negative bacteria, protozoa, viruses, fungal infections. Experience with the use of povidone-iodine solution in surgical practice indicates a decrease in the likelihood of wound suppuration when using solution Betadine ^® before surgical treatment or suturing. The use of various dosage forms of povidone-iodine in the treatment of problematic wounds reduces the amount of purulent discharge, swelling and pain in the focus of inflammation ⁷ . In this case, the cleansing and healing of wounds occur more actively than when using other antiseptic agents ⁷ .

Instruction

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In surgery, povidone-iodine (Betadine ^® ) is used as ⁹ :

• 10% solution for external use
• 10% ointments
• for use in drainage systems A 10% solution is diluted 10 to 100 times.
• vaginal suppositories (suppositories), 200 mg

Solution Betadine ^® disinfect the surgical field, treat the hands of medical personnel before surgery.

Solution and ointment Betadine ^® is used for disinfecting care and treatment of postoperative wounds and sutures.

According to studies in the treatment of infected wounds under wipes soaked in solution or ointment Betadine ^® , during the first 5-7 days the edema and the amount of purulent discharge decreased, there was a decrease in pain ⁸ .

Vaginal suppositories Betadine ^® (suppositories) is prescribed before planned operations in gynecology or after surgical treatment to prevent purulent complications.

Watch how to treat wounds in a short video with surgeon Fyodor Yanovich Kraskovsky

Prevention of wound infections

To prevent infection of everyday wounds, it is necessary to treat the damaged area immediately after the injury with an aqueous solution of an antiseptic agent. It is possible to treat only the edges of the damaged area and the area around the wound with alcohol solutions.

In case of planned surgical intervention, preoperative preparation is important – elimination of foci of chronic infection in the patient’s body. Before invasive manipulations (injections and surgery), the skin of the patient and staff is carefully treated with special disinfectants.

To prevent suppuration after surgery, a short course of antibacterial drugs is prescribed. If a purulent complication still appears, timely sanitation of the focus of infection is carried out. Treatment of purulent wounds is carried out in specialized medical institutions.

Treatment of wounds

How to properly treat wounds to avoid complications in damaged skin areas.

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Frequently Asked Questions

What can be used to treat a household wound?

Wash the wound immediately after injury.

The main task at this stage is to mechanically remove contamination with a large amount of liquid and reduce the “microbial number” – the number of bacteria in the wound. For this, a solution of chlorhexidine, an isotonic solution of sodium chloride 0.9%, or pure cooled boiled water is suitable. After that, it is necessary to treat the wound with a 10% solution of Betadine ^® and apply a clean bandage, with a small wound channel, you can use a medical plaster.

A 10% undiluted solution of Betadine ^® can be used to treat wounds and abrasions.

In case of large wounds and bleeding, it is recommended to seek immediate medical attention.

What is the best choice for “cauterization” of abrasions?

The majority of the first-aid kit has a “brilliant green”, a solution of fucorcin or a 5% alcohol solution of iodine. However, it is worth remembering that an alcoholic solution of iodine is not applied directly to the wound, and brilliant green and fukortsin leave a bright spot behind them. Moreover, the burning sensation caused by alcohol solutions causes discomfort when used in both children and adults.

A modern means for cauterizing abrasions is an iodine-containing aqueous solution on a polymer basis – Betadine ^® . It is devoid of the disadvantages of old-generation alcohol-containing antiseptics: it does not permanently stain the skin, does not sting when used even on fresh wounds. In addition, it has a wide spectrum of action against most infectious agents.

How can a patient reduce the risk of wound infection?

In case of domestic injuries, it is necessary to properly treat the damaged area of ​​the skin.

During surgical manipulations, strictly follow the doctor’s recommendations for the treatment and care of the wound.

If you experience throbbing pain, increased swelling in the area of ​​manipulation or fever in the area of ​​the wound and fever – consult a doctor.

Elena Mikhailovna Moshkova

Dermatovenereologist, Head of the CDO for the provision of paid services, St. Petersburg State Budgetary Institution of Healthcare “City Dermatovenerological Dispensary”, St. Petersburg

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Povidone iodine

Characteristics and properties of povidone iodine. What is povidone-iodine used for? Instructions for use of the solution, ointment, suppositories Betadine ^® with povidone-iodine.

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References

1. Piksin I.N., Pigachev A.V., Kistkin A.I., Ippolitov I.Yu. Wounds and wound infection”// Textbook// Saransk 2012.
2. Rudnov V.A. Clinical guidelines for the diagnosis and treatment of severe sepsis and septic shock in medical institutions of St. Petersburg// Bulletin of anesthesiology and resuscitation 2016;13(5):88-94.
3. Klyuchevsky V.V. Injury surgery//Guide for paramedics, surgeons, traumatologists// JSC Rybinsk Printing House 2004, Yaroslavl.
4. Instructions for medical use methylene blue, radar.
5. Instructions for medical use of furatsilin, RLS.