Wound: Wikis

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Wound
Classification and external resources

Wounded man
ICD-10 T14.0-T14.1
ICD-9 872-893
MeSH D014947

In medicine, a wound is a type of injury in which skin is torn, cut or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound). In pathology, it specifically refers to a sharp injury which damages the dermis of the skin.

Contents

Classification

An open wound
A laceration to the leg
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Open

Open wounds can be classified according to the object that caused the wound. The types of open wound are:

  • Incisions or incised wounds, caused by a clean, sharp-edged object such as a knife, a razor or a glass splinter.
  • Lacerations, irregular tear-like wounds caused by some blunt trauma. The term laceration is commonly misused in reference to incisions.
  • Abrasions (grazes), superficial wounds in which the topmost layer of the skin (the epidermis) is scraped off. Abrasions are often caused by a sliding fall onto a rough surface.
  • Puncture wounds, caused by an object puncturing the skin, such as a nail or needle.
  • Penetration wounds, caused by an object such as a knife entering and coming out from the skin .
  • Gunshot wounds, caused by a bullet or similar projectile driving into or through the body. There may be two wounds, one at the site of entry and one at the site of exit, such is generally known as a through-and-through.

Closed

Closed wounds have fewer categories, but are just as dangerous as open wounds. The types of closed wounds are:

  • Contusions, more commonly known as bruises, caused by a blunt force trauma that damages tissue under the skin.
  • Hematomas, also called a blood tumor, caused by damage to a blood vessel that in turn causes blood to collect under the skin.
  • Crush injury, caused by a great or extreme amount of force applied over a long period of time.
  • Chronic and Acute Acute or traumatic wounds are the result of injuries that disrupt the tissue. Chronic wounds are those that are caused by a relatively slow process that leads to tissue damage. Chronic wounds include pressure, venous, and diabetic ulcers. Typically, an insufficiency in the circulation or other systemic support of the tissue causes it to fail and disintegrate. Infection then takes hold of the site and becomes a chronic abscess. Once the infection hits a critical point, it can spread locally or become systemic (sepsis).

Pathophysiology

To heal a wound, the body undertakes a series of actions collectively known as the wound healing process.

Management

Wound, sewn with four stitches

Treatment of recent lacerations involves examination, cleaning, and closing the wound. If the laceration occurred some time ago it may be allowed to heal by secondary intention due to the high rate of infection with primary closure.

Cleaning

For simple lacerations cleaning can be accomplished using a number of different solutions including tap water, sterile saline solution, or antiseptic solution. Infection rates may be lower with the use of tap water in regions were water quality is high.[1] Evidence for the effectiveness of any cleaning of simple wound however is limited.[1]

Closure

If closure of a wound is decided upon a number of techniques can be used. These include Bandaids, a Cyanoacrylate glue, staples, and sutures.

Absorbable sutures have the benefit over non absorbable sutures of not requiring removal. They are often preferred in children.[2]

Complications

Bacterial infection of wound can impede the healing process and lead to life threatening complications. Scientists at Sheffield University have identified a way of using light to rapidly detect the presence of bacteria. They are developing a portable kit in which specially designed molecules emit a light signal when bound to bacteria. Current laboratory-based detection of bacteria can take hours or even days.[3]

History

Medieval treatment of wound with lance grittings

From the Classical Period to the Medieval Period, the body and the soul were believed to be intimately connected, based on several theories put forth by the philosopher Plato. Wounds on the body were believed to correlate with wounds to the soul and vice versa; wounds were seen as an outward sign of an inward illness. Thus, a man who was wounded physically in a serious way was said to be hindered not only physically but spiritually as well. If the soul was wounded, that wound may also eventually become physically manifest, revealing the true state of the soul.[4] Wounds were also seen as writing on the "tablet" of the body. Wounds gotten in war, for example, told the story of a soldier in a form which all could see and understand, and the wounds of a martyr told the story of their faith.by Dr.Sajjad Ahmad (Hebei North Med Univ Zhangjiakou China)[4]

See also

References

  1. ^ a b Fernandez R, Griffiths R (2008). "Water for wound cleansing". Cochrane Database Syst Rev (1): CD003861. doi:10.1002/14651858.CD003861.pub2. PMID 18254034.  
  2. ^ "BestBets: Absorbable sutures in pediatric lacerations.". http://www.bestbets.org/bets/bet.php?id=874.  
  3. ^ "Light to detect wound infection" (web). UK scientists have identified a way of using light to rapidly detect the presence of bacteria. bodat. BBC News. 11 March 2007. http://news.bbc.co.uk/1/hi/health/6427787.stm. Retrieved 2008-03-17.  
  4. ^ a b Reichardt, Paul F. (1984). "Gawain and the image of the wound". PMLA 99 (2): 154–161. doi:10.2307/462158.  

External links


1911 encyclopedia

Up to date as of January 14, 2010

From LoveToKnow 1911

Medical warning!
This article is from the 1911 Encyclopaedia Britannica. Medical science has made many leaps forward since it has been written. This is not a site for medical advice, when you need information on a medical condition, consult a professional instead.

WOUND (0. Eng. wund,connected with a Teutonic verb, meaning to strive, fight, suffer, seen in O. Eng. winnan, whence Eng. "win"), a solution in the continuity of the soft parts of the body. Contused wounds, or bruises, are injuries to the cellular tissues in which the skin is not broken. In parts where the tissues are lax the signs of swelling and discoloration are more noticeable than in the tenser tissues. The discoloration is caused by haemorrhage into the tissues (ecchymosis), and passes from dark purple through green to yellow before it disappears. If a considerable amount of blood is poured forth into the injured tissues it is termed a haematoma. The treatment of a bruise consists in the application of cold lotion, preferably an evaporating spirit-lotion, to limit the subcutaneous bleeding. The haemorrhage usually becomes absorbed of its own accord even in haematomata, but should suppuration threaten an incision must be made and the cavity aseptically evacuated.

Open wounds are divided into incised, lacerated, punctured and gunshot wounds. Incised wounds are made by any sharp instrument and have their edges evenly cut. In these wounds there is usually free haemorrhage, as the vessels are cleanly divided. Lacerated wounds are those in which the edges of the wound are torn irregularly. Such injuries occur frequently from accidents with machinery or blunt instruments, or from bites by animals. The haemorrhage is less than from incised wounds, and the edges may be bruised. Punctured wounds are those in which the depth is greater than the external opening. They are generally produced by sharp-pointed instruments. The chief danger arises from puncture of large bloodvessels, or injury to important structures such as occur in the thorax and abdomen. It is also difficult to keep such wounds surgically clean and to obtain apposition of their deeper parts, and septic germs are often carried in with the instrument.

The treatment of incised wounds is to arrest the bleeding (see Haemorrhage), cleanse the wound and its surroundings, removing all foreign bodies (splinters, glass, &c.), and obtain apposition of the cut surfaces. This is usually done by means of sutures or stitches of silk, catgut, silkwormgut or silver wire. If the wound can be rendered aseptic, incised wounds usually heal by first intention. In lacerated wounds there is danger of suppuration, sloughing, erysipelas or tetanus. These wounds do not heal by first intention, and there is consequently considerable scarring. The exact amount of time occupied in the repair depends upon the presence or not of septic material, as lacerated wounds are very difficult to cleanse properly. Carbolic acid lotion should be used for cleansing, while torn or ragged portions should be cut away and provision made for free drainage. It is not always possible to apply sutures at first, but the wound may be packed with iodoform gauze, and later, when a clean granulating surface has been obtained, skin-grafting may be required. In extensive lacerated wounds, where the flesh has been stripped from the bones, where there is spreading gangrene, or in such wounds in conjunction with comminuted fractures or with severe sepsis supervening, amputation of a limb may be called for. Punctured wounds should be syringed with carbolic lotion, and all splinters and foreign bodies removed. The location of needles is rendered comparatively easy by the use of the Röntgen rays; the wound can then be packed with gauze and drained. If a large vessel should have been injured, the wound may have to be laid open and the bleeding vessel secured. Should paralysis indicate that a large nerve has been divided, the wound must also be laid open in order to suture the injured structure.

It is only possible here to mention some of the special characteristics of gunshot wounds. In the modern small-bore rifle (LeeMetford, Mauser) the aperture of entry is small and the aperture of exit larger and more slit-like. There is usually but little haemorrhage. Should no large vessel be torn, and should no portion of septic clothing be carried in, the wound may heal by first intention. Such bullets may be said to disable without killing. They may drill a clean hole in a bone without a fracture, but sometimes there is much splintering. Abdominal wounds may be so small that the intestine may be penetrated and adhesions of neighbouring coils of intestine cover the aperture. Martini-Henry bullets make larger apertures, while soft-nosed or "dum-dum" bullets spread out as soon as the bullet strikes, causing great mutilation and destruction of the tissues. Shell wounds cause extensive lacerations. Small shot may inflict serious injury should one of the pellets enter the eye. In gunshot wounds at short distance the skin may be blackened owing to the particles of carbon lodging in it. The chief dangers of gunshot wounds are haemorrhage, shock and the carrying in of septic material or clothing into the wound.


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Simple English

Simple English Wiktionary has the word meaning for:
File:Chapter1figure1-Superficial bullet
Superficial bullet wounds

In medicine, a wound is a type of physical trauma where in the skin is torn, cut or punctured (an open wound), or where blunt force trauma causes a bruise (a closed wound).

In pathology, it specifically means a sharp injury which damages the dermis of the skin.

Healing

To heal a wound, the body undertakes a series of actions collectively known as the wound healing process.

Other websites

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  • WOUNDS, online open-access journal featuring articles about wound care and related research.
  • Ostomy Wound Management, online open-access journal featuring articles about wound care, ostomy care, incontinence care and nutrition
  • Journal of Burns and Wounds, online open-access journal featuring articles about wound care and related research

Other pages

Injury


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