Classification of wounds
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This document defines and classifies different types of wounds. It discusses that wounds involve a loss of skin or mucous membrane continuity and may also involve underlying tissues. Wounds are classified as either tidy or untidy, and acute or chronic. Tidy wounds are clean cuts while untidy wounds contain devitalized tissue. Examples of different wound types are provided such as incisions, lacerations, abrasions, puncture wounds, and crush injuries. Chronic wounds like pressure sores and ulcers are also described as having prolonged inflammation and sloughing of necrotic tissue. Key reference sources are listed.
Classification of wounds
- 1. Resource Faculty: Dr. Rohit Yadav Presented by: Ashish Kr. Tripathi
- 2. A wound is: A loss of continuity of the skin or mucous membrane, which may involve soft tissues, muscle, bone and other anatomical structures Collier 1994
- 3. Wounds Rank and Wakefield Classification Tidy Wounds Untidy Wounds Duration Acute Wounds Chronic Wounds
- 4. Most useful from practical point of View Classified as Tidy and Untidy Tidy Wounds Untidy Wounds Incised Crushed Or Avulsed Clean Contaminated Healthy tissue Devitalized Tissue Seldom Tissue Loss Often Tissue Loss
- 5. • Inflicted by Sharp Instruments • No devitalized Tissue • Skin wounds will usually be single and clean cut • Tendons, arteries and nerves will commonly be injured but repair is usually possible • Fractures are uncommon • Eg: surgical Incisions, Glass cuts, Knife wounds
- 6. Tidy Wound (Picture Source: Bailey and Love)
- 7. Tidy Wound (Picture Source: Bailey and Love)
- 8. • Result from Tearing, Crushing, Avulsion, Vascular Injury or Burns • Contains devitalized tissue • Skin wounds will often be multiple and irregular • Tendons, arteries, Nerves: exposed, might be injured but usually not divided • Fractures: common and may be multi-fragmentary
- 9. Untidy Wound (Picture Source: Bailey and Love)
- 10. Untidy Wound (Picture Source: Bailey and Love)
- 11. Acute Wounds: Trauma Burns Chronic Wounds Pressure Sores Leg Ulcers
- 12. Bruise and Contusion: Injury caused by blunt force that damages small blood vessels and causes interstitial bleeding, usually without the disruption of the continuity of the tissue. Hematoma: When the amount of bleeding due to injury is sufficient enough to create localized swelling, it is called hematoma.
- 13. Contusion (Picture source: Robin and Cotran)
- 14. Puncture Wounds: is an open injury in which foreign materials and organisms are likely to be carried deeply into the underlying tissues. Eg: Nails, sharp objects, needles, bullets. Bite: Particular type of puncture wounds caused by animal bites(Eg. dogs, cats, humans etc.) which are associated with the high incidence of infection presumably from mouth organism.
- 15. Gun shot Puncture Injury (Picture Source: Robin and Cotran) A
- 16. Dog Bite Injury (Picture Source: Bailey and Love
- 17. Abrasion: Shearing injury of skin in which the surface is rubbed off. Most are superficial and will heal by epithelialization but some may result in skin thickness loss. Eg: skinned knees and elbow Friction Burns: Similar to abrasion but there will be an element of thermal damage as well as the abrasion. Eg: Rope burns, floor burns
- 18. Laceration: is an irregular tear in the skin produced by overstretching. May be linear or stellate depending on the tearing force. Immediate margins of lacerations are frequently hemorrhagic and traumatized. Eg: wounds made by dull knife, bomb fragments. Incision: cut made by sharp cutting objects such as knife (scalpel) or piece of glass. Margins are usually clean and there are no bridging strands of tissue
- 19. Laceration of Scalp (Picture Source: Robin and Cotran)
- 20. Avulsion: Open injury where there has been severe degree of tissue damage. Eg: Hands or limbs trapped in moving machinery like rollers. May produce a degloving injury. Degloving: Is caused by shearing forces that separate tissue planes rupturing their vascular interconnections and causing tissue ischaemia. Most frequently occurs between the subcutaneous fat and deep fascia. Can be open/closed, and localised or circumferential.
- 21. Degloving Injury of Hand (Picture Source: Bailey and Love) Degloving Injury of Buttocks (Picture Source: Bailey and Love)
- 22. Crush Injury: Variant of blunt injury often accompanied by degloving and compartment syndrome.
- 23. Breach in epithelial continuity Prolonged Inflammatory Response: overgrowth of granulation tissue, and scarring- leave a fibrotic margin Slough: Necrotic tissue often at the Ulcer center
- 24. Defined as tissue Necrosis with ulceration due to Prolonged Pressure Also called bed sores, pressure ulcers and decubitus ulcer Higher incidence in paraplegic, elderly and severely ill patients
- 25. Bailey and Love’s Short Practice of Surgery : 25th Edition. Robbins and Cotran Pathological Basis of Disease: 7th Edition.