Wounds Health Article

Definition

A wound occurs when the integrity of skin is compromised (e.g., skin breaks, 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. They may be chronic, as are pressure ulcers (which are common in persons with diabetes as a result of skin breakdown)—or they may be acute, as in gunshot wounds or an animal bites. Wounds may also be referred to as open, in which the skin has been compromised and underlying tissues are exposed. Alternatively, they may be closed. Here, the skin has not been compromised, but trauma to underlying tissue has occurred (e.g., a bruised rib or cerebral contusion). Emergency personnel generally place acute wounds in one of eight categories:

• Abrasions. Also called scrapes, they occur when the skin is rubbed away by friction against a rough surface (e.g., rope burns and skinned knees).
• Avulsions. Occur when an entire structure or part of it is forcibly pulled away, such as in the loss of a permanent tooth or an ear lobe. Explosions, gunshots, and animal bites may cause avulsions.
• Contusions. Also called bruises, these are the result of a 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. These are slicing wounds made with a sharp instrument, leaving even edges, or those made with a dull cutting instrument, which leaves uneven edges. Cuts may be as minimal as those caused by paper (i.e., paper cuts), or as significant as a surgical incisions.
• 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. Deep, narrow wounds produced by sharp objects such as nails, knives, and broken glass.

Causes and 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 injuries. Wounds may also be the intentional results of violence involving assault with weapons, including fists, knives, and guns.

The general symptoms of a wound are localized pain and bleeding. Descriptions of the appearance of different kinds of wounds are as follows:

• 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, length, and anatomical site. 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 in 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. Health care 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).

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.