Contusion & Lacero-contusion Wounds
Written by Rhiana Devadasan
Vulnus contusum = wounds caused by some blunt instrument or surface, which has struck part of the body in which skin lies over bony areas. (bruises/abrasions)
Characteristics of the wound:
- Irregular form
- Uneven & torn edges
- Irregular, livid edges that are cool on palpation
- Stupor localis (numbness)
- Local asphyxiation & necrotic parts on edges
- Lack of hemorrhage (bleeding)
- Opportunity & vulnerability to anaerobic infections (such as gangrene)
Vulnus laceratum = wounds caused by the tearing/pulling of soft tissue, where the epidermis is scraped off. (tearing wound)
Characteristics of the wound:
- Irregular form
- Irregular, jagged edges
- Epidermis is scraped off
- Underlying tissues & organs may be involved
- Often contaminated by bacteria & debris from the object that caused the cut
- Hemorrhages depend on the lumen of the vessel & size of the wound
Vulnus lacero-contusum = since both types of wounds require similar types of treament, they can be classed together as lacerocontusion wounds. These are usually located on the scalp.
Characteristics of the wound:
- Normally appear less alarming than simple incised wounds, but are actually more dangerous
- Conquassatio tecta
- Slow bleeding
- Traumatic shock
- Dangerous Gangrene
- The more severe the damage, the lower the pain (i.e. moderately contused wounds = severe pain. Severely contused wounds = destroyed organisation of tissues = barely any pain)
TREATMENT
- Wound closure = various suturing techniques:
- Skin may be closed with simple or mattress sutures using interrupted or continuous techniques.
- Knots should not be tied tightly, to allow swelling because of inflammation and to prevent necrosis at the skin edge.
- Mattress sutures ensure optimal eversion at the skin edge and appose deeper tissue, reducing the risk of formation of haematoma or seroma.
- The subcuticular suture is the most widely favoured technique and has good cosmetic results.
- Arterial anastomoses and arteriotomies are closed to ensure eversion, but gut anastomosis conventionally has an inverted suture line.
- Metal clips and staples are alternatives to conventional suturing:
- Despite the need for removal, they are associated with good cosmetic results and low infection rates.
- Adhesive strips are useful for closing superficial wounds:
- Used in emergency departments to close a child's forehead laceration without anaesthetic or tears.
- Allow wound swelling and are also associated with low infection rates.