Wounds
A) Skin involvement:
1) Open wound: when the whole thickness of
skin is opened (Laceration and Skin loss).
2) Closed wound: Skin is intact (not opened)
include crushing injury and contusions.
B) Etiology:
1) Abrasion(erosion) wound: caused by friction
with rough surface, there is damage to skin
consisting loss of epidermis and portions of dermis.
There is little bleeding, painful, heals slowly.
2) Avulsion wound: there is complete separation of
tissue caused by barbs.
3) Incision wound: this type of wound is caused by
sharp object characterized by smooth regular
wound edges.
4) Laceration wound: caused by barbs characterized
by irregular edges created by tearing of tissue.
5) Puncture wound: caused by sharp pointed object
most dangerous type of wound.
6) Penetrating wound: is a puncture wound caused
by sharp pointed object which penetrate one of
body cavities (Thoracic, Abdominal, Pelvic, or joint
cavity).
These wounds we can Treated by:
 Arresting the hemorrhage.
 Removed the foreign bodies and hair from
wound.
 Cleaning the wound with sterilized water or
normal isotonic solution.
 Applying an antiseptic lotion or antibiotic
powder to the wound.
 Dressing wound with sterilized gauze or
cotton-wool to prevent contamination.
 Regulated the wound edges to be clean cut
like incised wound.
 Suturing the lips of the wound.
 Applying a protective pad and bandage.
 Keeping the patient at rest.
 Giving the antibiotics and nursing for three
days.
7) Poisoned wounds: Caused by chemical or organic
toxins such as mineral, venom, or vegetable toxin.
8) Pathogenic wounds: Caused by some virus, bacteria,
…..etc. such as rabies, anthrax and tuberculosis.
These wounds we can Treated by:
 Arrest of the circulation from the wound towards
the heart.
 Washing the wound and compressing it from the
periphery towards the center to flush out the
poison.
 Sucking the wound, which is without danger when
the mucous membrane is intact.
 Cauterization of the wound with one of the
mineral acids or better by the hot iron.
 Irrigation of the wound with liquids which
neutralize.
 Administration
Antibiotics.
of
Antiseptics,
Antidote
or
9) Ulcerating wounds: is superficial wound
involving molecular destruction of tissue with
cannot healing caused by repeated irritation,
infection prevent healing or malignant tumors.
10) Burns wounds: caused by thermal, scalding,
friction, and freeze burns. These causes are
resulting simply forms of skin necrosis. Burns are
described by extent percentage of body surface and
depth of tissue damage (first, second , and third
degree).
11) Contused wounds: it is thick zone of dead
tissue, there is no breach in the surface of the
overlying skin, included three degree:
A) Contusions of the first degree: characterized by
rupture of capillary vessels in the skin and
subcutaneous tissues and the formation of
ecchymoeses.
Treatment:
These are benign affections which undergo
resolution, like all slight inflammatory conditions,
without any risk of complication. They may be
treated with cold and astringent applications to
arrest capillary hemorrhage, this lead to quick
recovery.
B) Contusions of the second degree: characterized
by rupture of large vessels and production of a
hematoma.
Treatment:
 The case is recent, treatment comprises:
 Cold water irrigation.
 Astringent applications.
 Compression with a pad and bandage at
effected part.
In the long standing case, treatment comprises:
 Incising the swelling at a dependent part.
 Evacuating its contents.
 Treating its lining with an irritant antiseptic
solution.
 The severe hemorrhage should be early opening
of hematoma before the ruptured vessels are
thrombosed it must be arrested by plugging the
cavity.
 Prognosis:it
is
undergo
inflammation,
granulation, and cicatrisation, and thus remove
the cavity.
C) Contusions of the third degree: there is big
destruction of tissue, which may undergo
gangrene.
Treatment:
 The moist warm antiseptic applications are
due to restore the circulation in the tissue
damaged to prevent gangrene.
 The antiseptic is added to counteract infection
that may enter through abrasions on the skin.
 If the patient suffers from shock the usual
treatment for this condition.
C) Degree of contamination:
A) Clean wound: is type of wound that’s
surgical created (under aseptic conditions). It
has minimal contamination, it can be
effectively removed.
B) Contaminated wound: when a wound had
occurred since 6-12 hours is called
contaminated wound. It divided into three
classes:
Contaminated class I:
bacterial proliferation.
there
is
little
Contaminated class II: there is large
bacterial proliferation, but bacteria still in
lag phase can’t invade tissue.
Contaminated class III: it called infected
wound, is the wound that had occurred
since more than 12 hours characterized by
presence of necrotic tissue or suppuration,
sometimes accompanied by systemic
reaction (fever, anorexia, …. etc.)