WOUNDS - TYPES AND MANAGEMENT

Presented By:
Dr. Fatima Jabbar
 WOUND:

A WOUND IS A BREAK IN THE CONTINUITY OF

SKIN ,MUCOUS MEMBRANE OR TISSUES CAUSED
BY PHYSICAL, CHEMICAL OR BIOLOGICAL INSULT.
 TYPES:
According to the etiology:
Surgical wounds: These are wounds caused by
surgical procedure
Penetrating wounds: Wounds caused by
penetrating trauma
Blunt wounds: Wounds caused by blunt
trauma
Burn wounds: Wounds caused by burn injurie
Rank and Wakefield’s classification:
Tidy wounds: They involve sharp clean edges and are
caused by sharp objects like knife and surgical
instruments ,often are clean and can be closed
primarily.

Untidy wounds: Those that involve crushed

,avulsed , burned and mangled parts ,often dirty and
require debridement and once converted to tidy
ones after excision of devitalized tissue are safely
closed or left to heal by secondary intention.
According to length of time since
formation:
Acute: <6 weeks ( no length of time since
formation underlying pathology , normal
inflammatory stage , acute wound fluid
support cell proliferation and are without
complication)
Chronic: >6weeks (underlying pathology ,
prolonged inflammatory stage ,chronic wound
fluid does not support cell proliferation and
complications may arise)
According to the integrity of the skin:
Open wounds :Type of wounds in which the skin has
been compromised and underlying tissues are
exposed .Examples include incised wounds,
laceration, punctured wounds etc.
Closed wounds : Wounds in which the skin has not
been compromised, but trauma to underlying
structures has occurred . Examples of closed wounds
are: Contusions - (more commonly known as a
bruise) - caused by blunt force trauma that damages
tissue under the skin
CLOSED WOUND OPEN WOUND
 According to wound depth :
Superficial wounds: Only the epidermis is affected . A truly superficial
wound does not bleed and heals within a few days .Examples include most
abrasions and blisters

Partial-thickness wounds: The epidermis and part of the dermis is

affected. A partial-thickness wound does bleed . If left uncovered, a blood
clot will cover the wound and a scar will form . A partial-thickness wound
can take from several days to several weeks to heal, depending on the
patient and the wound treatments chosen .

Full-thickness wounds: A full-thickness wound involves the epidermis and

the dermis. The underlying fatty tissue, bones, muscles, or tendons may
also be damaged. The full-thickness wound takes longer time to heal than
does a partial-thickness wound, sometimes as long as several months
 According to mode of injury:
Bruises / contusion: Caused by blunt trauma that damage the tissue under
the skin without breaking the skin . Characterized by skin discoloration due to
bleeding into the tissues .
Hematoma: These are also closed wounds caused by damage to a blood
vessel that in turn causes blood to collect under the skin.
Crush wounds: These occur when a heavy object falls onto a person,
splitting the skin and shattering or tearing underlying structures  They are
often accompanied by degloving injuries and compartment syndrome
Abrasions: An abrasion is a shearing injury of the skin in which the surface is
rubbed off . Most are superficial and will heal by epitheliazation.
Lacerated wound: Caused by tearing of tissues . Wounds have irregular
borders .
Puncture wounds: Greatest dimension depth . When pierces body cavity its
penetrating and if it passes through viscous its perforating.
Incised wounds: Greatest dimension is length and have clean edges with
clear margins
AVULSION AND CRUSH INJURIES
abrasion
 According to degree of contamination
Clean wounds: (INFECTIVE RISK <2%). No break in aseptic technique . Incision is
made under sterile conditions. No inflammation is encountered. The respiratory
tract, alimentary, genital or uninfected urinary tracts are not entered . Primary
closure . No drain . e.g. HERNIA,THYROID,BREAST.

Clean Contaminated wounds: (< 10%) Operative wounds in which the respiratory,
alimentary, genital or urinary tract is entered under controlled conditions and
without unusual contamination . e.g. ORAL SURGERY, GASTRIC, SMALL BOWEL
SURGERY, CHOLECYSTECTOMY

Contaminated wounds: (20%) Open, fresh or accidental wounds; operations with

major breaks in sterile technique or gross spillage from the gastrointestinal tract;
and incisions in which acute, non-purulent inflammation is encountered Eg
APPENDECTOMY (of perforated appendix)

Dirty or Infected wounds:( 40%) Old traumatic wounds with retained devitalized
tissue and those that involve existing clinical infection Eg DRAINAGE OF ABCESS.
 Management
 FIRST ABCDE
 RESUSSCITATION.INCLUDING PRESSURE ON THE
BLEEDING WOUND.
 TAKE HISTORY ; WHEN WAS THE ACCIDENT ?
 PROPHYLAXIS AGINST TETANUS.
 ANTIBIOTICS
 TAKE PATIENT TO THE THEATRE.
 CLEAN THE WOUND PROPERLY WITH NORMAL
SALINE ,ADD SOME ANTISEPTIC LIKE PYODINE .
 Management
INSPECT THE WOUND:

 CLEAN INCISED OF LESS THAN 6 HOURS DO PRIMARYSUTURING OR

CLOSURE(UPTO 24 HRS FOR FACE AND SCALP).ANY NERVE OR TENDON
CUT,DO SUTURING.

 IF CONTAMINATED DIRTY,CLEAN & WASH,DO N,T CLOSE THE WOUND

BUT LEAVE IT OPENED FOR 3 -7 DAYS AND THEN DO SUTURING SO
CALLED DELAYED PRIMARY SUTURING.(SOIL , ANIMAL BITES,
PROJECTILES)

 DO PROPER WOUND EXCISION AND DEBRIDEMENT INCLUDING

ALLDEAD TISSUES AND DEBRIS ,AND DO FASCIOTOMY IF THE LIMB
SWOLLEN & OEDEMATOUS AND PAINFUL.
 Management
 TO SUTURE OR NOTIF YOU HAVE A WOUND WHICH
YOU ARE IN SUSPICIOUN,REGARDING CLEANLINESS
OR CONTAMINATION DO NOT SUTURE.WHEN TO
REMOVE THE STICHES ?
 FACE , SCALP & NECK AFTER 5-7 DAYS AFTER SUTUR-
ING ,BECAUSE OF GOOD BLOOD SUPPLY.
ABDOMEN;AFTER 7-10 DAYS .
 UPPER LIMBS;AFTER 7-10 DAYS.BACK & LOWER
LIMBS 10-15 DAYS.
 NOTE:DO N,T COUNT DAY OF SURGERY.
THANKS