8 Types Of Wounds3
A wound can be a mere superficial skin abrasion (excoriation) or, when further tissue layers are damaged as well it can also have considerable depth (deep wound) and reach, and open, body cavities (penetrating wound).
On the type of force (e. g. cut with a sharp knife, stab with a dagger, hammer blow, entrance and exit of a bullet, crushing and tearing), its direction and the course of the grain of the skin, depends on the form of the wound-edges (split, defect, flap). The edges of the wound gape to a greater or lesser extent, according to the elasticity of the separated tissue, so that the edges of divided blood vessels, muscles, tendons and nerves are drawn far apart. Wounds in tissues without elastic elements (e. g. liver, kidneys, brain) scarcely gape at all. The condition of the edges of the wound is of very great importance in healing. We distinguish 8 types of wounds, according to their manner of production:
- contused wounds
- ruptured wounds
- gunshot wounds
Contused wounds occur when a blunt, smoothish force, e. g. a car wheel, a blow from a stick, stone or hoof, acts on the soft parts, with bones a short distance underneath, so that the soft parts are held between the force and the bones in a sort of press. The edges of the wound are lacerated, frequently undermined, suggillated and defectively nourished. All round, there is extensive excoriation of the skin. In the depths of the wound, muscles, tendons, fascial, blood vessels and nerves, and frequently bones as well, are crushed in the same way and lacerated or smashed. There is little bleeding from such wounds. The slightness of the pain is also in striking contrast to the severity of the injury, a phenomenon due to local shock.
In bursts, the force works from inside, outwards, e. g. a piece of broken bone piercing it way out, or a bullet coming out.
Tearing wounds occur when the covering skin, mucous membranes or organic serosa is pulled or stretched beyond the limits of its elasticity. The edges of the wound are irregular and lacerated.
These are caused by the more or less perpendicular action of sharp objects. The smooth wound edges thus produced gape according to the degree of elasticity of the tissue or the direction of the grain of the skin. It is consideration of these factors that governs whether one gets small soft scars or wide, ugly scars after operation. Bleeding from these «smooth» cuts is considerable; the everyday razor cut is a very good example. Any damage to deeper structures such as arteries and veins, nerves, tendons and joint capsules must be carefully excluded. The operative wound corresponds to the cut and shares with it its minimal tissue damage, severe bleeding and good healing tendencies.
An oblique force produces flap wounds, in which the skin and subcutaneous tissue remain attached only by a bridge of varying width.
In these a cutting force (e. g. an axe blow) strikes the tissue with great power vertically or diagonally. Apart from possible crushing of the wound-edges the slash wound is not essentially different from the cut.
Here, a pointed object penetrates into the tissue over a narrow surface. This far it resembles a cut. The danger of stab wound lies in the concomitant injury to large blood vessels and nerves, and in the opening of the cranial, thoracic or abdominal cavities or the joints. The cross-section of the wound edges corresponds to that of the instrument. The wound edges are generally stuck together and do not gape. A special type of stab wound is the impaling injury, in which a stake-like, blunt object, such as a stick or umbrella point, pointed wood or metal pole, penetrates into the body.
Gunshot wounds have very little in common with the wounds so far described. In spite of the frequency only calibre-sized skin defect at the entrance, the bullet is very destructive of tissue, particularly when it meets bones. As in stab wounds, the clinical course depends on the extent to which blood vessels, nerves, muscles, bones, joints and viscera are involved. The rougher and more jagged the surface of the missile, the more frightful is the damage caused in the depths and at the exit wound.
In wounds caused by the bite of man or animal, exceptionally virulent pathogenic organisms (human or animal passage) can be transmitted, and can produce in a very short time correspondingly dangerous pyogenic and putrid infections. In spite of their usual small extent, bites should not be lightly dismissed. Large bites, needing surgical management, are treated and left wide open.