Wound

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This article is about torn skin or bruising. For the band see Wounds (band).

In medicine, a wound is a type of physical trauma wherein the 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.

Before any medical or paramedical evaluation, a wound is considered as minor when:

• it is superficial (a "flesh wound");
• it is away from natural orifices;
• there is only minor bleeding;
• it was not caused by a tool or an animal.

Any other wound should be considered as severe. If there is any doubt, a wound should be considered as severe. "Severe" does not necessarily means that it endangers life, but it must at least be seen by a physician. In the case of severe open wounds, there is a risk of blood loss (which could lead to shock), and an increased chance of infection due to bacteria entering a wound that is exposed to air. Due to the risk of infection, wounds should be kept clean, and closed if possible until professional help is available.

Depending on their severity, closed wounds can be just as dangerous as open wounds. An injury to the brain such as a contusion is an extremely dire closed wound, and requires emergency medical attention.

Types of wound

Open

Open wounds can be classified into a number of different types, 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, a razor or a glass splinter. Incisions which involve only the epidermis are legally classified as cuts, rather than wounds.
• Lacerations - Irregular wounds caused by a blunt impact to soft tissue which lies over hard tissue (e.g. laceration of the skin covering the skull) or tearing of skin and other tissues such as caused by childbirth. Lacerations may show bridging, as connective tissue or blood vessels are flattened against the underlying hard surface. Commonly misused in reference to injury with sharp objects, which would not display bridging (connective tissue and blood vessels are severed).
• Abrasions (grazes) - a superficial wound in which the topmost layers of the skin (the epidermis) are scraped off, often caused by a sliding fall onto a rough surface.
• Puncture wounds - caused by an object puncturing the skin, such as a nail or needle.
• Penetration wounds - caused by an object such as a knife entering the body.
• 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.

In a medical context, all stab wounds and gunshot wounds should be considered major wounds.

Closed

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

• Contusions - (more commonly known as a bruise) - caused by blunt force trauma that damages tissue under the skin
• Hematoma - (also called a blood tumor) - caused by damage to a blood vessel that in turn causes blood to collect under the skin
• Crushing Injuries - caused by a great or extreme amount of force applied over a long period of time.

First aid

Main article history of wound care.

Severe/major open wound

The priority with major wounds is to prevent further blood loss. Treat the casualty to control the bleeding, prevent shock, and call for help as soon as possible.

1. Emergency medical services should be called.
2. Disposable gloves should be used. The casualty's clothing should be removed to expose the wound.
3. Get the casualty to raise the wound above the level of the heart (if the wound is in a limb) and, if there is no object embedded in the wound, apply direct pressure to the area with their own hand.
4. Help the casualty to lie down (on a blanket or carpet to protect them from the cold). If shock is suspected, raise the casualty's legs and support them on a chair or similar.
5. A sterile dressing should be applied (or if none is available, an improvised dressing made from a clean towel or cloth). The dressing should be secured with a bandage that is tight enough to maintain pressure on the wound (but not so tight as to impair circulation beyond the wound).
6. If blood seeps through the first dressing, a second dressing should be applied on top of the first. If blood continues to seep though the second, apply pressure to the appropriate artery. Maintain pressure on dressings by applying more gauze and wrapping. You should not remove a blood soaked bandage from the wound because it can interfere with the coagulation of the blood cells.
7. The injured part should be supported in a raised position - a leg supported on a chair, or an arm rested across the chest (so that it is above the level of the heart).

Puncture wound

• Stop the bleeding. Minor cuts and scrapes usually stop bleeding on their own. If they don't, apply gentle pressure with a clean cloth or bandage. If bleeding persists — if the blood spurts or continues to flow after several minutes of pressure — seek emergency assistance.

• Clean the wound. Rinse the wound well with clear water. A tweezers cleaned with alcohol may be used to remove small, superficial particles. If larger debris still remains more deeply embedded in the wound, see your doctor. Thorough wound cleaning reduces the risk of tetanus. To clean the area around the wound, use soap and a clean washcloth.

• Apply an antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or ointment (Neosporin, Polysporin) to help keep the surface moist. These products don't make the wound heal faster, but they can discourage infection and allow your body to close the wound more efficiently. Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment.

• Cover the wound. Exposure to air speeds healing, but bandages can help keep the wound clean and keep harmful bacteria out.

• Change the dressing regularly. Do so at least daily or whenever it becomes wet or dirty. If you're allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze and hypoallergenic paper tape, which doesn't cause allergic reactions. These supplies are generally available at pharmacies.

• Watch for signs of infection. See your doctor if the wound doesn't heal or if you notice any redness, drainage, warmth or swelling.

If an object is embedded in a wound

If there is an object (for example, broken glass) embedded in the wound, or an open fracture where a broken bone sticks through the skin, pressure should not be applied over the object or the object removed. Treat as follows:

1. Put on disposable gloves, if available, to protect yourself from infection.
2. Press firmly on either side of the embedded object to push the edges of the wound together.
3. If the wound is in a limb, raise and support the limb above the level of the heart.
4. Help the casualty to lie down (on a blanket or carpet to protect them from the cold). If you suspect that shock may develop, raise the casualty's legs and support them on a chair or similar.
5. Build up padding on either side of the object (using dressing pads, rolled-up bandages, or similar), so that you are able to bandage over the object without pressing on it.
6. Summon an ambulance, if you have not sent someone to do so already (alternatively if the wound is minor, the wound is not bleeding heavily, and the casualty is comfortable, arrange to transport the casualty to hospital by another means). Monitor the casualty's condition until help arrives.

Major closed wounds (hematoma and crushing injuries)

1. Ice - put ice on the wound (recommended in instances of 20 minutes on, 20 minutes off) Direct contact of ice with the skin is discouraged, as this may cause ice burns or abrasions. Wrapping the ice in a towel prevents this.
2. Compress - use a pressure dressing or manual compression to slow or stop bleeding (internal)
3. Elevate - if the injury is a limb, elevate injured tissue above the heart. This will help to keep the swelling down, which decreases pain.
4. Splint - If necessary, splint above and below the wound to slow or stop bleeding and to reduce pain.

Always be alert for shock in major closed wound patients. This can result from internal bleeding, so be sure to evaluate them for such.

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

References