Types of The Wound

4th JOGLOSEMAR CRANIOFACIAL FORUM

Solo, June 3rd-5th 2022
WOUND is damage or disruption of the integrity of biological
tissue, including skin, mucous membranes, and organ tissues
 Wound Appropriate Wound
evaluation treatment Healing
- Exact cause/etiology
- Location
- Type of the wound
Phases of Wound Healing
 Wound

Based on duration and nature of wound

Based on the depth of damage in wounds Based on appearance of wounds
healing

Superficial
Acute wounds Necrotic/eschar
wounds

Partial thickness
Chronic wounds Slough
of the wounds

Full thickness of
the wounds Granulation

Epithelialization

Infected,
Malodours
Acute Wound
• Heal within a predictable amount of time; in general 2 weeks in a healthy
person for most wounds

• Traumatic wound
• are injuries to the skin and underlying tissue caused by a force of some nature
• classified by the object that caused the force
 Abrasion

Avulsion/
Puncture
degloving

Open
Gunshot Laceration
Wound

Amputati
Bite
on

Burn
 Contusion

Closed Closed Concussion

degloving Wound

Hematoma
• Surgical wound
• are incisions made purposefully by a health care professional and are cut precisely,
creating clean edges around the wound.
• Surgical wounds may be closed (with stitches, staples or adhesive) or left open to heal.
• The healing process for surgical wounds is classified by their potential for infection.
Chronic wound
• Loss of continuity of the skin secondary to injury that persist for
longer than 6 weeks
• Chronic wounds are wounds that fail to heal properly or are in slow or
stagnated healing
• The reason for chronic wounds can be due to many things such as
diabetes, autoimmune diseases, chemical agents, radiotherapeutic
agents, infections, and peripheral vascular diseases 
• Common features of the chronic wound:
• Excessive and persistent inflammatory phase
• Impaired cell proliferation
• Abnormal cell migration
• Microbial colonization
• Presence of biofilm
• Inability to complete normal timeframe phases of wound healing
(most commonly in the inflammatory or proliferation phases)
• Classification:
• Pressure ulcers
• Diabetic ulcers
• Vascular ulcer (arterial and venous)
Pressure Injury
• A pressure injury is localized damage to the skin and underlying soft
tissue usually over a bony prominence or related to a medical or
other device.
Stage 1
• Intact skin with nonblanchable redness
• Painfull, firm, soft, warmer or cooler as compared with
surrounding

Stage 2
• Partial thickness loss of dermis without slough
• May also present as an intact or open/rupture blister
(serum/serous-sanginous)

Stage 3
• Full thickness tissue loss
• Subctaneous fat may be visible but bone, muscle, tendon is not
exposed
Stage 4
• Full thickness tissue loss with bone, tendon, or muscle exposed
• Slough or eschar may be present

Suspected Deep Tissue Injury

• Purple or maroon localized area of discolored intact skin or
blood-filled blister due to damage of underlying soft tisse

Unstageable
• Full thickness tissue loss in which actual depth of the ulcer is
completely obscured by slough and or eschar
Diabetic Ulcer
• Diabetes is a commonly encounter comorbidity in the population of
patients with wound
• Inhibits all phases if wound healing
 Grade 0 Grade 1 Grade 2
Impending skin Superficial skin ulcer, Deep ulcer,
lesion, presence of does not involve penetrating down to
predisposing bony subcutaneous tissue ligaments and
deformity or healed muscle, but no bone
ulcer involvement or
abscess formation
 Grade 3 Grade 4 Grade 5
Deep ulcer, with Localized Extensive
cellulitis abscess gangrenous gangrene
formation, often
with
osteomyelitis
Vascular Ulcer
• Venous, arterial or mixed etiology
• Venous >>
• The presence of any lower extremity wound requires an evaluation of
vascular status – will determine of the ability of the wound or surgical
incision to heal
 Arterial Ulcers Diabetic Ulcers Venous Ulcers
Predisposing Factors
Peripheral vascular disease (PVD) Patient with diabetes and Valve incompetence in perforating
Diabetes mellitus peripheral neuropathy veins
Advanced age Long-term uncontrolled or poorly History of deep vein
controlled diabetes thrombophlebitis and thrombosis
Previous history of ulcers
Obesity
Advanced age

Anatomic Location
Between toes or tips of toes On plantar aspect of foot On medial lower leg and ankle
Over phalangeal heads Over metatarsal heads On malleolar area
Around lateral malleolus Under heel
At sites of trauma or rubbing
footwear
 Arterial Ulcers
Patient Assessment
Thin, shiny, dry skin
Hair loss on ankle and foot
Thickened toenails
Pallor on elevation and dependent Palpable pulses
rubor
Cyanosis
Decreased temperature
Absent or diminished pulses
Diabetic Ulcers
Diminished or absent sensation in
foot
Foot deformities
Warm foot
Subcutaneous fat atrophy
Arterial assessment findings if
patient also has PVD
Venous Ulcers
Firm edema
Dilated superficial veins
Dry, thin, scaly skin
Evidence of healed ulcers
Periwound and leg
hyperpigmentation
Possible dermatitis

Wound Characteristics
Even wound margins
Gangrene or necrosis
Deep, pale wound bed
Blanched or purpuric periwound
tissue
Severe pain
Cellulitis
Minimal exudate
Even wound margins Irregular wound margins
Deep wound bed Superficial wound
Cellulitis or underlying Ruddy, granular tissue
osteomyelitis Usually minimal to moderate pain
Granular tissue present unless PVD Frequently moderate to heavy
is present exudate
Low to moderate drainage
Classification based on the Depth
• Burn injury, open wound, pressure injury

• Superficial wounds: only the epidermis

• Partial-thickness wounds: the epidermis and part of the dermis
• Full-thickness wounds: extend through the
epidermis and dermis
• Full-thickness wounds may extend into the
• subcutaneous tissue, fascia, muscle and bone
ESCHAR is nonviable or necrotic tissue that
covers all or part of a wound base
Vary in color (black, brown, gray, yellow, tan)
and texture (hard, dry, rubbery, soft ).
not synonymous with “scab”  a result of
blood and serum hardening over a fresh
wound
SLOUGH
The soft yellow substance on the wound
surface is a result of autolysis of subcutaneous GRANULATION tissue is composed of new
or connective tissue. capillaries in an extracellular matrix and has a
Slough has no texture granular, beefy red appearance

EPITHELIALISATION is the formation of INFECTED WOUND; periwound erythema,

epithelium over a denuded surface; The drainage, sloughing, failure to heal, pain,
epithelium manifests as light pink warmth