Module 1 - Wound care & Healing

Types of Wounds

1.)   Lacerations – Injury where tissue is cut or torn. For treatment, tissue is first cleansed of any blood clots and foreign material, débribed and irrigated. Local anesthetic is administered and atraumatic technique of wound closure is employed, where wound margins are realigned with careful regard to prevention of any further crush injury to tissues. Sterile dressings are applied and immobilization is recommended for complex extremity wounds.

2.)   Abrasions – Injury where a superficial layer of tissue is removed, as seen with 1st degree burns. The wound is cleansed of any foreign material, sometimes employing a scrub brush to prevent traumatic tattooing by dirt and gravel, and should be performed within the first day of injury. Local anesthetic can be used for pain, however treatment of the wound is non-surgical, using moist dressings and a topical antibiotic to protect the wound and aid healing.

3.)   Contusions – Injuries resulting from a forceful blow to the skin and soft tissue, however leaving the outer layer of skin intact. These injuries generally require minimal care as there is no open wound. However, contusions should be evaluated for possible hematoma deep to the surface or other tissue injuries that may indicate more severe morbidity. An expanding hematoma can damage overlying skin and demands evacuation.

4.)   Avulsions – Injuries where a section of tissue is torn off, either partially or in total. In partial avulsions, the tissue is elevated but remains attached to the body. A total avulsion means that the tissue is completely torn from the body with no point of attachment. In the case of a partial avulsion where the torn tissue is still well-vascularized and viable, the tissue is gently cleansed and irrigated and the flap is reattached to its anatomical position with a few sutures. If the torn tissue is non-viable, it is often excised and the wound closed using a skin graft or local flap. In the case of a total avulsion, the tissue is often very thick and demands debulking and defattening methods before it can be regrafted. Major avulsions describe amputation of extremities, fingers, ears, nose, scalp or eyelids and require treatment by a replant team.

Author: SP Zinn