WOUNDS

• A wound is defined as a break in the continuity of

the skin or mucous membrane or simply tissue
damage.
• Wounds can be used to describe injury to an organ
or tissue within the body e.g. wound of muscles
and organs such as the liver, stomach and so on.
• DEPTH of the wound is more important than
AREA
 CAUSES OF WOUND

• TRAUMA ( industrial injuries, road traffic accidents,

war injuries etc)
• BURNS
• INFECTION
TRAUMA:
• This is a damage caused by an external force. There
are two types of trauma: Open and Closed.

• Open wound
• 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.
•.
• Puncture wounds, caused by an object
puncturing the skin, such as a nail or needle
 OTHERS
• Abrasions (grazes or scrapes), 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 OR 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
• Penetrating wounds, caused by an object such as a
knife entering and coming out from the skin.
Penetrating wounds have point of entry and point of
exit. The EXIT wound is usually LARGER than the
entrance wound.
• 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, generally referred to as a "through-
and-through."
Closed wound
• 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 damage 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
 Features or Characteristics of wounds
• Incised wound: - this is a wound in which the edges are
sharp and well defined.
• This type of wound may bleed freely or profusely
because blood vessels have been cut across and are
prevented from contracting.
• However, this wound can usually be cleaned
satisfactorily and tend to heal quickly leaving but a little
scar.
• Edges of an incised wound may remain in apposition or
closed together but more often, they tend to gape
especially when the injured part is moved in certain
directions.
• Lacerated wound: - A lacerated wound is one in which
the edges are jagged, irregular and often bruised, the skin
and tissues are torn and the edges of the wound are irregular.
The skin and muscles are crushed.
• It is usually caused by a blow with a blunt instrument or by a
fall on a rough surface.
• It occurs if a limb is cut up in machinery or road accident,
during scratching by the nails or because, the blood vessels
have been twisted in the process of tearing and therefore
cannot readily bleed.
• Wounds of this type heal slowly leaving a considerable scar.
It has a high risk of sepsis because it is a good medium for
growth of microorganisms.
• Punctured wound: -
• this is usually caused by a blow from a sharp
instrument such as a nail, tip of knife or a dagger or a
gunshot which passes straight through the skin to any
depth.
• The depth of the wound is greater than the length.
• There is a danger of deep organs been damaged. This
type of wound is very dangerous.
• Although the actual wound may appear quite small
on the surface, there is often a much deeper wound
called “track” hidden under the skin which may
damage internal organs.
• Microorganisms can grow easily and produce severe
complications.
• Dog bites are often of this variety and are mostly
deceptive for what may appear to be nothing more
than a slight cut, may prove on more thorough
examination to extend quite deeply under the skin in
various directions.
Contused wound: -
• A contused wound is any wound which is
associated with bruising.
• There may be little skin damage but underlying
tissues may be severely damaged with bleeding
from vessels under the skin.
• It is caused by violence from a blunt instrument
such as hitting the finger with the hammer.
• There may be very little external bleeding but quite
considerable internal bleeding.
BURNS:
as a result of;
• Wet - Hot water
or hot liquids
• Dry- sunlight or
flame
• Electrical
• INFECTION: -
• Boils: also known as furuncle is an infection of the
hair follicle that has a small collection of pus called
an abscess (reddened and often painful swellings on
the skin).
• Carbuncles: (large painful swelling under the skin) or
rounded red gemstones or painful cluster of boils
connected to each other under the skin
•
Wounds can also be classified as:
• Acute and Chronic
• Acute wounds are the result of injuries that disrupt the
tissue.
• Acute wound progressess to healing within two weeks
however when patients has an underlying medical
condition or decreased nutrients and oxygen supply,
acute wound may fail to heal in time and become
chronic.
• Chronic wounds are those that are caused by a
relatively slow process that leads to tissue damage.
• They are aggravated stage of an acute wound. Chronic
wounds include pressure, venous, and diabetic ulcers.
• This can result from diabetes, auto immune disease,
infection, peripheral vascular disease
 Management
• AIMS OF FIRST AID in wound care is to
• Stop bleeding.
• To treat and prevent shock
• Minimise germs or micro-organisms from entering the
wound (prevent infection or contamination).
• Obtain medical attention

Note
• Different types of wounds require specific first aid
• All wounds have risk of infection
 General principles in Wound care (immediate)
• Wash hands before attending to the wound (wear medical
or exam gloves if available or if you are at the hospital).
• Gently wash wound with soap and water. Rinse for 3 to 5
minutes.
• Clean wound to prevent infection unless it is very large
or bleeding seriously. Cleaning should be done by using
clean materials as much as possible E.g. cotton gauze,
towels etc...
• Do not use alcohol, hydrogen peroxide, on wound
• Avoid breathing or blowing on wound
• Remove any large particles if you can.
• Do not attempt to remove clothing stuck to wound.
• Cut around clothing and leave in place
• Do not scrub wound
• Do not waste time cleaning a wound that is bleeding
severely – controlling bleeding is always the priority.
• Do not try to clean major wound after controlling bleeding
– it may bleed again
• Pat area dry.
• Cover wound with sterile dressing and bandage.
• NB. Do not put antibiotic ointment on puncture or deep
wound (Use only on abrasions and shallow wounds).
Specific management
• Punctured wound
• Greater risk is infection
• Germs or micro organism may not be flushed out
• Remove small objects or dirt (not impaled object)

For stabbed wound (with impaled objects)

• Removing an object could cause more injury
and bleeding
• Leave it in place and dress wound around it
 • Control bleeding by applying direct pressure at
sides of object.
• Pad object in place with large dressings or folded
cloth
• Support object while bandaging it in place
• Keep victim still
• Seek medical attention

• NB. Do not put antibiotic ointment on puncture or

deep wound (Use only on abrasions and shallow
wounds)
• Penetrating wound
• If the object (eg. Missile) lodges in the body and
fails to exit, DO NOT attempt to remove it.
• OR If there is an object extending from the wound
(impaled in), DO NOT remove the object
• Apply a dressing around the object and use
additional improvised bulky materials/dressings
(use the cleanest material available) to
build up the area around the object.
•
Avulsion
• Try to move skin or tissue into normal position
(unless contaminated)
• Control bleeding
• Provide other wound care
• If avulsed body part is completely separated – care
for it like an amputation
In amputation,
• Control bleeding with direct pressure
• Elevate extremity
• Treat victim for shock
• Wrap severed part in dry, sterile dressing or clean
cloth (do not wash)
• Place the part in plastic bag, seal it
• Place sealed bag in another bag/container with ice
• Part should not touch ice directly
• Give part to responding crew
• Dangers of wounds: - The three chief dangers of
wound in order of urgency of treatment are
haemorrhage, shock and sepsis.
• At greater risk are wounds from bites, puncture
wounds, dirty wounds, wounds with jagged
edges
 Complications Associated with Wounds
• Infection: when there is wound, microorganisms can
enter easily to cause infection.

• Haemorrhage: Damage to the blood vessels causes

loss of blood. Haemorrhage may be slight or severe
and may be internal or external.

• Shock: The shock depends upon the extent of

damage. It is not very severe in lacerated and
contused wounds.
• Injury to the vicinity: Wounds are often associated
with injury to the other important structures in the
vicinity like blood vessels, nerves and tendons
muscles.

• Injury to deeper organs: Organs like the liver,

spleen, the lungs, kidneys, heart may damage when
there is punctured wounds and may cause internal
haemorrhage.

• Fractures: Injury to a limb as seen in road accidents

and machinery may cause one or more bones to break.
 Process of wound healing

• Wound healing is a natural restorative response to

tissue injury.
• Healing is the interaction of a complex cascade of
cellular events that generates resurfacing,
reconstitution, and restoration of the tensile strength
of injured skin.
• Healing is a systematic process, traditionally
explained in terms of 3 classic phases: inflammation,
proliferation and maturation/ Remodeling phases
HEALING OF WOUNDS
There are two main ways

Healing by regeneration
Healing by replacement (scar formation)
 HEALING BY
REGENERATION
Inflammatory phase

• Following incision of the skin, a 5- to 10-minute period of

vasoconstriction ensues, mediated by epinephrine,
norepinephrine, prostaglandins, serotonin, and
thromboxane.
• Within 24 hours of the initial injury, neutrophils,
monocytes and macrophages are on the scene to control
bacterial growth and remove dead tissue.
• It is Characterized by redness, heat, pain and
swelling. Characteristic red color and warmth is
caused by the capillary blood system increasing
circulation & laying foundation for epithelial growth.
• Last approximately 4 to 5 days. Platelet activity stops
bleeding & triggers the immune response
Proliferative phase
• Begins within 24 hours of the initial injury and may
continue for up to 21 days. It is characterized by three
events:
• Granulation Formation of new capillaries that generate
and feed new tissue. Granulation tissue is the beefy red
tissue that bleeds easily
• Epithelialization : Formation of an epithelial layer that
seals and protects the wound from bacteria and fluid
loss. It is essential to have a moist environment to foster
growth of this layer. It is a very fragile layer that can be
easily destroyed with aggressive wound irrigation or
cleansing of the involved area.
Collagen synthesis: Creates a support matrix for the
new tissue that provides it with its strength.
• Oxygen, iron, vitamin C, zinc, magnesium & protein
are vital for collagen synthesis.
• This stage is the actual rebuilding and is influenced
by the overall patient condition of the wound bed
Maturation/Remodeling phase

• Final stage of wound healing

• Begins around day 21 and may continue for up to 2
years
• Collagen synthesis continues with eventual closure of
the wound and increase in tensile strength
• Tensile strength reaches only about 80% of pre-injury
strength
 HEALING (BY REPLACEMENT)
This can be classified into healing by First intention or
granulation depending on the type and the nature of the
wound

First Intention:
This method is more satisfactory and quicker method of
healing. It occurs in incised wounds, when the edges
can be brought together and kept in position while
healing continues. The edges of a wound can be
brought together in one of two ways:
• By stitching, clips or adhesive dressing
• By position. Most incised wounds gape when the injured
part is moved in certain directions. Often the position of the
affected part can be so altered that the edges of the wound
come together.

• In the process of healing by first intention, blood clots

temporarily hold the edges of the wound together, where
new cells are growing to replace those destroyed by the
accident.
• Healing by first intention can occur in healthy wounds,
where sepsis has been avoided by suitable treatment. The
process usually takes from five to ten days.
• Granulation: This is a slower method of healing and
occurs in lacerated wounds and those which have become
septic. New cells, which at first immature grow in clusters
in the depths of wound. Each cluster appears like a small
clot of blood, and is called granulations.
• The granulations increase in size and gradually grow
upwards until they reach the surface of the wound, when
new cells grow across from the skin edges and so
complete the healing process. Healing by granulation also
takes place sometimes under the scab produced by
superficial wounds, such as a graze.
 FACTORS AFFECTING WOUND HEALING

Several factors affect the process of wound healing.

These include the following:
• Presence of infection
• Anaemia: there is less supply of oxygen to the tissues
• Some disease conditions such Diabetes Mellitus that
reduces collagen synthesis
• Age: wound heals faster in children than in adults
• Obesity: decreases blood supply to fatty tissue
• Nutritional deficiency
• Foreign bodies
• Poor technique in wound dressing .e.g too tight a
dressing impede blood supply
• Drugs e.g steroids
• Poor general health
• Smoking: Nicotine in cigarette is a potent vasoconstrictor
which impede blood supply to the area
• Wound stressors like vomiting, coughing,
straining :produces tension on wound