開放創

WordNet

without undue constriction as from e.g. tenseness or inhibition; "the clarity and resonance of an open tone"; "her natural and open response"
a clear or unobstructed space or expanse of land or water; "finally broke out of the forest into the open" (同)clear
information that has become public; "all the reports were out in the open"; "the facts had been brought to the surface" (同)surface
a tournament in which both professionals and amateurs may play
become available; "an opportunity opened up" (同)open_up
become open; "The door opened" (同)open_up
cause to open or to become open; "Mary opened the car door" (同)open_up
make available; "This opens up new possibilities" (同)open_up
start to operate or function or cause to start operating or functioning; "open a business" (同)open_up
not sealed or having been unsealed; "the letter was already open"; "the opened package lay on the table" (同)opened
used of mouth or eyes; "keep your eyes open"; "his mouth slightly opened" (同)opened
not brought to a conclusion; subject to further thought; "an open question"; "our position on this bill is still undecided"; "our lawsuit is still undetermined" (同)undecided, undetermined, unresolved
affording unobstructed entrance and exit; not shut or closed; "an open door"; "they left the door open" (同)unfastened
(set theory) of an interval that contains neither of its endpoints
accessible to all; "open season"; "an open economy"
affording free passage or access; "open drains"; "the road is open to traffic"; "open ranks"
begin or set in action, of meetings, speeches, recitals, etc.; "He opened the meeting with a long speech"
display the contents of a file or start an application as on a computer
have an opening or passage or outlet; "The bedrooms open into the hall"
having no protecting cover or enclosure; "an open boat"; "an open fire"; "open sports cars"
make the opening move; "Kasparov opened with a standard opening"
not having been filled; "the job is still open"
not requiring union membership; "an open shop employs nonunion workers"
open to or in view of all; "an open protest"; "an open letter to the editor"
ready for business; "the stores are open"
first or beginning; "the memorable opening bars of Beethovens Fifth"; "the plays opening scene"
opportunity especially for employment or promotion; "there is an opening in the sales department"
a recognized sequence of moves at the beginning of a game of chess; "he memorized all the important chess openings" (同)chess opening
a vacant or unobstructed space that is man-made; "they left a small opening for the cat at the bottom of the door"
becoming open or being made open; "the opening of his arms was the sign I was waiting for"
the act of opening something; "the ray of light revealed his cautious opening of the door"
an open or empty space in or between things; "there was a small opening between the trees"; "the explosion made a gap in the wall" (同)gap
the first performance (as of a theatrical production); "the opening received good critical reviews" (同)opening_night, curtain raising
a ceremony accompanying the start of some enterprise
the initial part of the introduction; "the opening established the basic theme"
put in a coil
an injury to living tissue (especially an injury involving a cut or break in the skin) (同)lesion
the act of inflicting a wound (同)wounding
a casualty to military personnel resulting from combat (同)injury, combat injury
a figurative injury (to your feelings or pride); "he feared that mentioning it might reopen the wound"; "deep in her breast lives the silent wound"; "The right reader of a good poem can tell the moment it strikes him that he has taken an immortal wound--t
people who are wounded; "they had to leave the wounded where they fell" (同)maimed
made open or clear; "the newly opened road"

PrepTutorEJDIC

…‘を'『開く』,開ける;…‘の'ふた(おおい)をとる / …‘を'『切り開いて作る』,開拓する;…‘を'全開通させる《+『名』+『up,』+『名』+『up』》 / …‘を'『広げる』《+『up』+(『out』)+『名,』+『名』+『up』(『out』)》 / …‘を'『始める』 / …‘を'開業する,開店する,開場する / (人に)〈心など〉‘を'打ち明ける,〈秘密など〉‘を'漏らす《+『名』+『to』+『名』》 / (新思想などに)〈心・目〉‘を'開く《+『名』+『to』+『名』》 / 〈戸などが〉『開く』,あく / 〈花・つぼみが〉開く《+『out』》 / 〈学校などが〉『始まる』;〈店などが〉開く / 〈道路などが〉開通する / (…に)向かって開いている,(…に)通じている《+『out』『on』(『upon,to,onto』)+『名』》 / 《副詞[句]を伴って》〈風景などが〉広がる,ひらける / 本を開く;(…)ページを開く《+『to』(《英》『at』)+『名』》 / (窓・口などが)『開いた』,開いている;(包みなどが)広げられて / (花が)咲いた / (店などが)『開いている』,開業している;(催し物が)『公開の』,だれでも入れる / 《名詞の前にのみ用いて》ふたのしてない,屋根のない,おおいのない / 広く開いた,さえぎるものがない / 公然の / 率直な,遠慮しない / さらされている,無防備の / 《補語にのみ用いて》(職・地位などが)空位の;(時間などが)あいている / (問題・議事などが)未解決の / 凍結しない,雪や霜の降らない;温和な / (漁・猟が)解禁の / (音声が)開口音の;開音節の / 《the~》戸外,野外 / 空き地;(樹木のない)開けた場所,平野
〈C〉(森・垣根・壁などの)空いている所;空き地;すき間,穴 / 〈C〉(物語・会議などの)始め,出だし,冒頭(beginning) / 〈C〉(…の地位の)空き,就職口《+『for』(『at, in』)+『名』》(vacant) / 〈C〉(劇などの)初演 / 〈U〉(…が)開くこと,あくこと《+『of』+『名』》 / 〈C〉(…の)よい機会,好機《+『for』+『名』》 / 初めの,開始の
windの過去・過去分詞
(身体の)『傷』,負傷 / (感情・自尊心などに対する)『痛手』,傷《+to+『名』》 / …‘を'『負傷させる』 / 〈感情など〉‘を'傷つける,〈人〉‘の'感情などを傷つける
(特に戦争で)負傷した;(感情などが)傷つけられた

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/06/06 09:20:28」(JST)

wiki en

A wound is a type of injury in which skin is torn, cut, or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound). In pathology, it specifically refers to a sharp injury which damages the dermis of the skin.

Classification

According to level of contamination a wound can be classified as

clean wound, a wound made under sterile conditions where there are no organisms present in the wound and the wound is likely to heal without complications.
contaminated wound, where the wound is as a result of accidental injury where there are pathogenic organisms and foreign bodies in the wound.
infected wound, where the wound has pathogenic organisms present and multiplying showing clinical signs of infection, where it looks yellow, oozing pus, having pain and redness.
colonized wound, where the wound is a chronic one and there are a number of organisms present and very difficult to heal as in a bedsore.

Open

Open wounds can be classified according to the object that caused the wound. The types of open wound are:

Incisions or incised wounds, caused by a clean, sharp-edged object such as a knife, razor, or glass splinter.
Lacerations, irregular tear-like wounds caused by some blunt trauma. Lacerations and incisions may appear linear (regular) or stellate (irregular). The term laceration is commonly misused in reference to incisions.
Abrasions (grazes), superficial wounds in which the topmost layer of the skin (the epidermis) is scraped off. Abrasions are often caused by a sliding fall onto a rough surface.
Avulsions, injuries in which a body structure is forcibly detached from its normal point of insertion. A type of amputation where the extremity is pulled off rather than cut off.
Puncture wounds, caused by an object puncturing the skin, such as a splinter, nail or needle.
Penetration wounds, caused by an object such as a knife entering and coming out from the skin.
Gunshot wounds, caused by a bullet or similar projectile driving into or through the body. There may be two wounds, one at the site of entry and one at the site of exit, generally referred to as a "through-and-through."

Closed

Closed wounds have fewer categories, but are just as dangerous as open wounds. The types of closed wounds are:

Hematomas, also called a blood tumor, caused by damage to a blood vessel that in turn causes blood to collect under the skin.
- Hematomas that originate from internal blood vessel pathology are petechiae, purpura, and ecchymosis. The different classifications are based on size.
- Hematomas that originate from an external source of trauma are contusions, also commonly called bruises.
Crush injury, caused by a great or extreme amount of force applied over a long period of time.

An open wound (an avulsion)
A laceration to the leg
An infected puncture wound to the bottom of the forefoot.
A puncture wound from playing darts.
An incision: a small cut in a finger.

Pathophysiology

To heal a wound, the body undertakes a series of actions collectively known as the wound healing process.

Management

Wound, sewn with four stitches

The overall treatment depends on the type, cause, and depth of the wound as well as whether or not other structures beyond the skin (dermis) are involved. Treatment of recent lacerations involves examining, cleaning, and closing the wound. Minor wounds, like bruises, will heal on their own, with skin discoloration usually disappearing in 1–2 weeks. Abrasions, which are wounds with intact skin (non-penetration through dermis to subcutaneous fat), usually require no active treatment except keeping the area clean, initially with soap and water. Puncture wounds may be prone to infection depending on the depth of penetration. The entry of puncture wound is left open to allow for bacteria or debris to be removed from inside.

Cleaning

Evidence to support the cleaning of wounds before closure is poor.^[1] For simple lacerations, cleaning can be accomplished using a number of different solutions, including tap water and sterile saline solution.^[1] Infection rates may be lower with the use of tap water in regions where water quality is high.^[1] Cleaning of a wound is also known as wound toilet.^[2]

Closure

If a person presents to a healthcare center within 6 hours of a laceration they are typically closed immediately after evaluating and cleaning the wound. After this point in time, however, there is a theoretical concern of increased risks of infection if closed immediately.^[3] Thus some healthcare providers may delay closure while others may be willing to immediately close up to 24 hours after the injury.^[3] A single study has found that using clean non sterile gloves is equivalent to using sterile gloves during wound closure.^[4]^[5]

If closure of a wound is decided upon a number of techniques can be used. These include bandages, a cyanoacrylate glue, staples, and sutures. Absorbable sutures have the benefit over non absorbable sutures of not requiring removal. They are often preferred in children.^[6] Buffering the pH of lidocaine makes the freezing less painful.^[7]

Adhesive glue and sutures have comparable cosmetic outcomes for minor lacerations <5 cm in adults and children.^[8] The use of adhesive glue involves considerably less time for the doctor and less pain for the person with the cut. The wound opens at a slightly higher rate but there is less redness.^[9] The risk for infections (1.1%) is the same for both. Adhesive glue should not be used in areas of high tension or repetitive movements, such as joints or the posterior trunk.^[8]

Dressings

In the case of surgical wounds, the use of topical antibiotics on does not reduce infection rates in comparison with non-antibiotic ointment or no ointment at all.^[10] Antibiotic ointments will irritate the skin, slow healing, and greatly increase risk of developing contact dermatitis and antibiotic resistance.^[10] Because of this, they should only be used when a person shows signs of infection and not as a preventative.^[10]

The effectiveness of dressings and creams containing silver to prevent infection or improve healing is not currently supported by evidence.^[11]

Imaging

A wound may be recorded for follow-up and observing progress of healing with different techniques which consist of, but not limited to:^[12]

Photographs, with subsequent area quantification using computer processing
Wound tracings on acetate sheets
Kundin wound gauge

Complications

The patient has a deep wound at the knee, and radiography is used to ensure there are no hidden bone fractures.

Bacterial infection of wound can impede the healing process and lead to life-threatening complications. Scientists at Sheffield University have identified a way of using light to rapidly detect the presence of bacteria. They are developing a portable kit in which specially designed molecules emit a light signal when bound to bacteria. Current laboratory-based detection of bacteria can take hours or even days.^[13]

Workup

Individuals who have wounds that are not healing should be investigated to find the causes. Many microbiological agents can be responsible for this. The basic workup includes evaluating the wound, its extent and severity. Cultures are usually obtained both from the wound site and blood. X rays are obtained and a tetanus shot may be administered if there is any doubt about prior vaccination ^[14]

Chronic

Non-healing wounds of the diabetic foot are considered one of the most significant complications of diabetes, representing a major worldwide medical, social, and economic burden that greatly affects patient quality of life. Almost 24 million Americans—one in every 12—are diabetic and the disease is causing widespread disability and death at an epidemic pace, according to the Centers for Disease Control and Prevention. Of those with diabetes, 6.5 million are estimated to suffer with chronic or non-healing wounds. Associated with inadequate circulation, poorly functioning veins, and immobility, non-healing wounds occur most frequently in the elderly and in people with diabetes—populations that are sharply rising as the nation ages and chronic diseases increase.

Although diabetes can ravage the body in many ways, non-healing ulcers on the feet and lower legs are common outward manifestations of the disease. Also, diabetics often suffer from nerve damage in their feet and legs, allowing small wounds or irritations to develop without awareness. Given the abnormalities of the microvasculature and other side effects of diabetes, these wounds take a long time to heal and require a specialized treatment approach for proper healing.

As many as 25% of diabetic patients will eventually develop foot ulcers, and recurrence within five years is 70%. If not aggressively treated, these wounds can lead to amputations. It is estimated that every 30 seconds a lower limb is amputated somewhere in the world because of a diabetic wound. Amputation often triggers a downward spiral of declining quality of life, frequently leading to disability and death. In fact, only about one third of diabetic amputees will live more than five years, a survival rate equivalent to that of many cancers.

Many of these lower extremity amputations can be prevented through an interdisciplinary approach to treatment involving a variety of advanced therapies and techniques, such as debridement, hyperbaric oxygen treatment therapy, dressing selection, special shoes, and patient education. When wounds persist, a specialized approach is required for healing.^[15]

History

Medieval treatment of wound with lance grittings

From the Classical Period to the Medieval Period, the body and the soul were believed to be intimately connected, based on several theories put forth by the philosopher Plato. Wounds on the body were believed to correlate with wounds to the soul and vice versa; wounds were seen as an outward sign of an inward illness. Thus, a man who was wounded physically in a serious way was said to be hindered not only physically but spiritually as well. If the soul was wounded, that wound may also eventually become physically manifest, revealing the true state of the soul.^[16] Wounds were also seen as writing on the "tablet" of the body. Wounds acquired in war, for example, told the story of a soldier in a form which all could see and understand, and the wounds of a martyr told the story of their faith.^[16]

Research

In humans and mice it has been shown that estrogen might effect the speed and quality of wound healing.^[17]

References

^ ^a ^b ^c Fernandez, R; Griffiths, R (Feb 15, 2012). "Water for wound cleansing". In Fernandez, Ritin. Cochrane database of systematic reviews (Online) 2: CD003861. doi:10.1002/14651858.CD003861.pub3. PMID 22336796. Cite uses deprecated parameters (help)
^ Simple wound management on patient.co.uk website, viewed 2012-01-08
^ ^a ^b Eliya, MC; Banda, GW (Sep 7, 2011). "Primary closure versus delayed closure for non bite traumatic wounds within 24 hours post injury". In Eliya, Martha C. Cochrane database of systematic reviews (Online) 9 (9): CD008574. doi:10.1002/14651858.CD008574.pub2. PMID 21901725. Cite uses deprecated parameters (help)
^ Perelman, VS; Francis, GJ, Rutledge, T, Foote, J, Martino, F, Dranitsaris, G (March 2004). "Sterile versus nonsterile gloves for repair of uncomplicated lacerations in the emergency department: a randomized controlled trial". Annals of Emergency Medicine 43 (3): 362–70. doi:10.1016/j.annemergmed.2003.09.008. PMID 14985664. Cite uses deprecated parameters (help)
^ van den Broek, PJ (2011). "[Sterile gloves are necessary in minor surgery]". Nederlands tijdschrift voor geneeskunde 155 (18): A3341. PMID 21466736.
^ "BestBets: Absorbable sutures in pediatric lacerations".
^ Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R (2010). "Adjusting the pH of lidocaine for reducing pain on injection". In Tzortzopoulou, Aikaterini. Cochrane Database Syst Rev 12 (12): CD006581. doi:10.1002/14651858.CD006581.pub2. PMID 21154371.
^ ^a ^b Cals, JW; de Bont EGPM (2012). ". Minor incised traumatic laceration". BMJ 345: e6824. doi:10.1136/bmj.e6824. PMID 23092899. Cite uses deprecated parameters (help)
^ Farion, K; et al (2002). "Tissue adhesives for traumatic lacerations in children and adults". In Farion, Ken J. Cochrane Database Syst Rev (3): CD003326. doi:10.1002/14651858.CD003326. PMID 12137689. Cite uses deprecated parameters (help)
^ ^a ^b ^c American Academy of Dermatology (February 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (American Academy of Dermatology), retrieved 5 December 2013 , which cites
- Sheth, V. M.; Weitzul, S. (2008). "Postoperative topical antimicrobial use". Dermatitis : contact, atopic, occupational, drug 19 (4): 181–189. PMID 18674453.
^ D'Amico G, Pagliaro L, Pietrosi G, Tarantino I (2010). "Emergency sclerotherapy versus vasoactive drugs for bleeding oesophageal varices in cirrhotic patients". In d'Amico, Gennaro. Cochrane Database Syst Rev 3 (3): CD002233. doi:10.1002/14651858.CD002233.pub2. PMID 20238318.
^ Thomas, AC; Wysocki, AB (February 1990). "The healing wound: a comparison of three clinically useful methods of measurement.". Decubitus 3 (1): 18–20, 24–5. PMID 2322408. Retrieved 15 June 2013. Cite uses deprecated parameters (help)
^ "Light to detect wound infection" (web). UK scientists have identified a way of using light to rapidly detect the presence of bacteria. bodat. BBC News. 11 March 2007. Retrieved 2008-03-17.
^ Work Up eMedicine General Surgery. Retrieved on 2010-01-27
^ "The Clinical Case for Use of Hyperbaric Oxygen Therapy in the Treatment of Diabetic Wounds," Diversified Clinical Services, copyright 2009
^ ^a ^b Reichardt, Paul F. (1984). "Gawain and the image of the wound". PMLA 99 (2): 154–161. doi:10.2307/462158. JSTOR 462158.
^ Desiree May Oh, MD, Tania J. Phillips, MD (2006). "Sex Hormones and Wound Healing". Wounds.

External links

Wikiquote has a collection of quotations related to: Wounds

Look up wound in Wiktionary, the free dictionary.

Wikimedia Commons has media related to Wounds.

US based wound healing society
Association for the Advancement of Wound Care AAWC
European Wound Management Association - EWMA works to promote the advancement of education and research.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 創傷管理の基本原則 basic principles of wound management
2. 創傷治癒および治癒しない創傷の危険因子 wound healing and risk factors for non healing
3. 縫合糸による皮膚創傷部の閉鎖 closure of skin wounds with sutures
4. 胸骨創傷合併症の外科的管理 surgical management of sternal wound complications
5. 重度の四肢外傷の手術管理 surgical management of severe extremity injury

English Journal

Modification of polysaccharides: Pharmaceutical and tissue engineering applications with commercial utility (patents).

Malviya R1, Sharma PK2, Dubey SK3.
Materials science & engineering. C, Materials for biological applications.Mater Sci Eng C Mater Biol Appl.2016 Nov 1;68:929-38. doi: 10.1016/j.msec.2016.06.093. Epub 2016 Jun 30.
Polymer modifications open new era for the development of polymers with requisite properties. Use of modified polymers is practically boundless. Different studies focus on biomedical applications of chemically modified polysaccharides. Development and utilization of modified polysaccharides get atte
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Development of a new antibacterial biomaterial by tetracycline immobilization on calcium-alginate beads.

Ozseker EE1, Akkaya A2.
Carbohydrate polymers.Carbohydr Polym.2016 Oct 20;151:441-51. doi: 10.1016/j.carbpol.2016.05.073. Epub 2016 May 24.
In recent years, increasing risk of infection, caused by resistant microorganism to antibiotics, has become the limelight discovery of new and natural antibacterial materials. Heavy metals, such as silver, copper, mercury and titanium, have antibacterial activity. Products, which improved these meta
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Downregulation of miR-18a induces CTGF and promotes proliferation and migration of sodium hyaluronate treated human corneal epithelial cells.

Guo Y1, Lu X2, Wang H3.
Gene.Gene.2016 Oct 10;591(1):129-36. doi: 10.1016/j.gene.2016.07.008. Epub 2016 Jul 5.
Properly controlled corneal epithelial wound healing is critical for health of cornea, which involves cell proliferation, migration, anchoring and differentiation. Sodium hyaluronate (SH) has been proven to exert beneficial pharmacological effect on corneal wound healing, though the underlying mecha
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