Wounds Health Article

Definition

A wound occurs when the integrity of any tissue is compromised, for example, when skin breaks, muscle tears, burns, or bone fractures. A wound may be caused by an act, such as a gunshot, fall, or surgical procedure; by an infectious disease; or by an underlying condition.

Description

Types and causes of wounds are wide ranging, and health care professionals have several different ways of classifying them. They may be chronic, such as the skin ulcers caused by diabetes mellitus, or acute, such as a gunshot wound or animal bite. Wounds may also be referred to as open, in which the skin has been compromised and underlying tissues are exposed, or closed, in which the skin has not been compromised, but trauma to underlying structures has occurred, such as a bruised rib or cerebral contusion. Emergency personnel and first-aid workers generally place acute wounds in one of eight categories:

• Abrasions. Also called scrapes, they occur when the skin is rubbed away by friction against another rough surface (e.g. rope burns and skinned knees).
• Avulsions. These occur when an entire structure or part of it is forcibly pulled away, such as the loss of a permanent tooth or an ear lobe. Explosions, gunshots, and animal bites may cause avulsions.
• Contusions. Also called bruises, these result from forceful trauma that injures an internal structure without breaking the skin. Blows to the chest, abdomen, or head with a blunt instrument (e.g. a football or a fist) can cause contusions.
• Crush wounds occur when a heavy object falls onto a person, splitting the skin and shattering or tearing underlying structures.
• Cuts are slicing wounds made with a sharp instrument, leaving even edges. They may be as minimal as a paper cut or as significant as a surgical incision.
• Lacerations. Also called tears, these are separating wounds that produce ragged edges. They are produced by a tremendous force against the body, either from an internal source as in childbirth, or from an external source like a punch.
• Missile wounds. Also called velocity wounds, they are caused by an object entering the body at a high speed, typically a bullet.
• Punctures are deep, narrow wounds produced by sharp objects such as nails, knives, and broken glass.

Causes & symptoms

Acute wounds have a wide range of causes. Often, they are the unintentional results of motor vehicle accidents, falls, mishandling of sharp objects, or sports-related injury. Wounds may also be the intentional result of violence involving assault with weapons, including fists, knives, or guns.

The general symptoms of a wound are localized pain and bleeding. Specific symptoms include:

• An abrasion usually appears as lines of scraped skin with tiny spots of bleeding.
• An avulsion has heavy, rapid bleeding and a noticeable absence of tissue.

• A contusion may appear as a bruise beneath the skin or may appear only on imaging tests; an internal wound may also generate symptoms such as weakness, perspiration, and pain.
• A crush wound may have irregular margins like a laceration; however, the wound will be deeper and trauma to muscle and bone may be apparent.
• A cut may have little or profuse bleeding depending on its depth and length; its even edges readily line up.
• A laceration too may have little or profuse bleeding; the tissue damage is generally greater and the wound's ragged edges do not readily line up.
• A missile entry wound may be accompanied by an exit wound, and bleeding may be profuse, depending on the nature of the injury.
• A puncture wound will be greater than its length, therefore there is usually little bleeding around the outside of the wound and more bleeding inside, causing discoloration.

Diagnosis

A diagnosis is made by visual examination and may be confirmed by a report of the causal events. Medical personnel will also assess the extent of the wound and what effect it has had on the patient's well-being (e.g. profound blood loss, damage to the nervous system or skeletal system). In cases of severe injury, or when a physician suspects possible internal injury, tests might be made to determine the extent of a wound. In late 2001, a new ultrasound (imaging inside the body via sound waves) technique was introduced that might help doctors diagnose internal bleeding, a serious complication of some injuries. The technique could help prevent invasive surgery for diagnosis.

Treatment

Treatment of wounds involves stopping any bleeding, then cleaning and dressing the wound to prevent infection. Additional medical attention may be required if the effects of the wound have compromised the body's ability to function effectively.