Open Trauma & Wounds
Written by Rhiana Devadasan
- Open trauma - wounds.
- Contusion and lacero-contusion wound.
- Cut wounds. Bite wounds.
- Gunshot wounds. Puncture wounds.
Wound = a type of physical trauma whereby the integrity of the skin/mucosa/other tissue is compromised. It is caused by physical, chemical, biological or radiological agents and is followed by functional disorders & clinically expressed with local & general symptoms.
Classification of Wounds
Based on etiology:
- Blunt trauma wounds (falls, assults, sports injuries, bites)
- Penetrating trauma wounds (stab and gunshot)
- Surgical insult wounds
- Burn injury wounds (thermal, chemical, electrical, radiation, cold burns)
Based on Rank-Wakefield classification system:
- Tidy wounds
- sharp object used
- contains no devitalized tissue
- e.g. surgical incisions, cut from glass, knife wounds
- Untidy wounds
- from crushing, tearing avulsion, vascular injury, burns
- contains devitalised tissue
- usually multiple & irregular
- commonly associated with fractures
Based on duration of wound healing:
- Acute wounds
- immediately up to a few weeks healing time
- due to trauma or an operative procedure
- Chronic wounds
- failure to heal until 4 weeks - 3 months
- wound occurs due to underlying condition, such as extended pressure on tissues, poor circulation, poor nutrition
- e.g. pressure ulcers, venous leg ulcers, diabetic foot ulcers
Based on integrity of the skin:
- Open wounds
- skin has been compromised & underlying tissues are exposed
- e.g. incised wounds, lacerations, puncture wounds
- Closed wounds
- trauma to underlying structures, but skin is not commpromised
- e.g. contusions (bruising) or hematoma
Based on wound depth:
- Superficial wounds
- only epidermis affected
- usually does not bleed
- heals in a few days
- e.g. abrasions, blisters
- Partial-thickness wounds
- epidermis & part of dermis is affected
- bleeding is seen
- blood clot will cover the wound & a scar will form
- Full thickness wounds
- epidermis & dermis is damaged & underlying fatty tissue, bones, muscles or tendons
- cannot be sutured, healing process will form new tissue to fill the wound
Based on degree of contamination:
- Clean wounds
- no break in aseptic technique
- no inflammation
- respiratory, alimentary, genital or urinary tracts are not entered
- no drain
- e.g. herniorrhaphy (the surgical repair of a hernia)
- Contaminated wounds
- open, fresh or accidental wounds
- major breaks in sterile technique OR gross spillage from GIT
- incisions in which acute, non-purulent inflammation is encountered
- Dirty/Infected wound
- old traumatic wounds w/ retained devitalized tissue & those that contain existing clinical infection
Based on severity:
- Simple wounds
- integrity of the skin is traumatised without loss/destruction of tissue & w/o the presence of a foreign body