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Classification

  • According to level of contamination a wound can be classified as
  • Clean wound, a wound made under sterile conditions where there are no organisms present in the wound and the wound is likely to heal without complications.
  • Contaminated wound, where the wound is as a result of accidental injury where there are pathogenic organisms and foreign bodies in the wound.
  • Infected wound, where the wound has pathogenic organisms present and multiplying showing clinical signs of infection, where it looks yellow, oozing pus, having pain and redness.
  • Colonized wound, where the wound is a chronic one and there are a number of organisms present and very difficult to heal.
  • 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, razor, or glass splinter.
  • Lacerations, irregular tear-like wounds caused by some blunt trauma. Lacerations and incisions may appear linear (regular) or stellate (irregular). 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.
  • Avulsions, injuries in which a body structure is forcibly detached from its normal point of insertion. A type of amputation where the extremity is pulled off rather than cut off.
  • Puncture wounds, caused by an object puncturing the skin, such as a splinter, 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, generally referred to 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:

  • Hematomas, also called a blood tumor, caused by damage to a blood vessel that in turn causes blood to collect under the skin.
  • Hematomas that originate from internal blood vessel pathology are petechiae, purpura, and ecchymosis. The different classifications are based on size.
  • Hematomas that originate from an external source of trauma are contusions, also commonly called bruises.
  • Crush injury, caused by a great or extreme amount of force applied over a long period of time.

The overall treatment depends on the type, cause, and depth of the wound as well as whether or not other structures beyond the skin (dermis) are involved. Treatment of recent lacerations involves examining, cleaning, and closing the wound. Minor wounds, like bruises, will heal on their own, with skin discoloration usually disappearing in 1–2 weeks. Abrasions, which are wounds with intact skin (non-penetration through dermis to subcutaneous fat), usually require no active treatment except keeping the area clean, initially with soap and water. Puncture wounds may be prone to infection depending on the depth of penetration. The entry of puncture wound is left open to allow for bacteria or debris to be removed from inside.

Cleaning

Evidence to support the cleaning of wounds before closure is poor. For simple lacerations, cleaning can be accomplished using a number of different solutions, including tap water and sterile saline solution. Infection rates may be lower with the use of tap water in regions where water quality is high. Cleaning of a wound is also known as wound toilet.

Closure

If a person presents to a healthcare center within 6 hours of a laceration they are typically closed immediately after evaluating and cleaning the wound. After this point in time, however, there is a theoretical concern of increased risks of infection if closed immediately.Thus some healthcare providers may delay closure while others may be willing to immediately close up to 24 hours after the injury. A single study has found that using clean non sterile gloves is equivalent to using sterile gloves during wound closure.

If closure of a wound is decided upon a number of techniques can be used. These include bandages, 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. Buffering the pH of lidocaine makes the freezing less painful.

Adhesive glue and sutures have comparable cosmetic outcomes for minor lacerations <5 cm in adults and children. The use of adhesive glue involves considerably less time for the doctor and less pain for the person with the cut. The wound opens at a slightly higher rate but there is less redness. The risk for infections (1.1%) is the same for both. Adhesive glue should not be used in areas of high tension or repetitive movements, such as joints or the posterior trunk.

Dressings

In the case of clean surgical wounds, there is no evidence that the use of topical antibiotics reduces infection rates in comparison with non-antibiotic ointment or no ointment at all. Antibiotic ointments can irritate the skin, slow healing, and greatly increase the risk of developing contact dermatitis and antibiotic resistance.Because of this, they should only be used when a person shows signs of infection and not as a preventative.

The effectiveness of dressings and creams containing silver to prevent infection or improve healing is not currently supported by evidence

Quelle: Wickipedia

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