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 OF
WOUNDS
A. OPEN
Open wounds can be classified according to the object that caused the
wound. The types of open wound are:
1.
Incisions or incised wounds, caused by a clean, sharp-edged object such
as a knife,
a razor
or a glass splinter.
2.
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.
3.
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.
5.
Penetration wounds, caused by an object such as
a knife entering and coming out from the skin .
6.
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."
B. CLOSED
Closed wounds have fewer categories, but are just as dangerous as open
wounds. The types of closed wounds are:
1.
Contusions, more commonly known as bruises, caused
by a blunt force trauma that damages tissue
under the skin.
2.
Hematomas,
also called a blood tumor, caused by damage to a blood vessel
that in turn causes blood
to collect under the skin.
3.
Crush injury, caused by a
great or extreme amount of force applied over a long period of time.
TREATMENT OF WOUNDS
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. If there is a delay in treatment and the laceration occurred
more than 6-24 hours before evaluation, it may be preferable to heal by secondary intention, due to the high rate of
infection associated with delayed closure. 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. Most
abrasions tend to have an overall better appearance post-healing when kept
moist for about a week with an ointment, such as aquaphor healing ointment or
vasoline. 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 WOUNDS
For simple lacerations, cleaning can be accomplished using a number of
different solutions, including tap water, sterile saline solution, or an antiseptic
solution, such as hydrogen peroxide. Infection rates may be lower with the use
of tap water in regions where water quality is high. Evidence for the
effectiveness of any cleaning of simple wound however is limited. Cleaning
of a wound is also known as wound toilet.
CLOSING WOUNDS
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. Thus some
healthcare providers may delay closure while others may be willing to
immediately close up to 24 hours after the injury. A single study has found
that using clean non sterile gloves is equivalent to using sterile gloves
during wound closure.
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. Buffering the pH of lidocaine
makes the freezing less painful.
DRESSING WOUNDS
The effectiveness of dressings and creams containing silver to prevent
infection or improve healing is not currently supported by evidence.
Egg Oil
has been used in treating wounds and injuries. Ambroise Paré
used a solution of egg yolk, oil of roses, and turpentine for war wounds, an
old method that the Romans had discovered 1000 years before him. He published
his first book 'The method of curing wounds caused by arquebus and firearms' in
1545.
Egg Oil
is a natural emollient,
and may be used externally on burn wounds, where it reduces pain and promotes
re-epithilisation while minimising scars. It has been used effectively against
burns in rural Ethiopia.
ANTIBIOTICS USED
Most clean open wounds do not require any antibiotics
unless the wound is contaminated or the bacterial cultures are positive. Excess
use of antibiotics only leads to resistance and side effects. All open wounds
should be cleaned at least twice a day with warm water and soap. Once the wound
is cleaned, it should be covered with moist gauze. This should be
followed by application of dry gauze and then the wound covered with a bandage.
The purpose of a wet to dry dressing allows the bandage to adhere to dead
tissue performing a mechanical debridement when removed.This allows new healthy
skin to grow and prevents debris from collecting. When the wound is clean, it
may be closed with a skin graft. No wound is ever closed if it is suspected to
be infected.
COMPLICATIONS
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.
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.
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.
REFERENCES
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PMID 18254034.
3.
Eliya, MC; Banda, GW (2011 Sep 7). Eliya, Martha C. ed. "Primary
closure versus delayed closure for non bite traumatic wounds within 24 hours
post injury". Cochrane database
of systematic reviews (Online) 9: CD008574. DOI:10.1002/14651858.CD008574.pub2.
PMID 21901725.
4.
Perelman, VS; Francis, GJ, Rutledge, T, Foote, J, Martino, F,
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van den Broek, PJ (2011). "[Sterile gloves are necessary in minor
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Nice post.
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