2) Closed wound:2) Closed wound: Skin is intact (not Skin is intact (not opened) include crushing injury and opened) include crushing injury and contusions.contusions.

WoundsWounds

A) Skin involvementA) Skin involvement::

1) Open wound:1) Open wound: when the whole when the whole thickness of skin is opened (Laceration thickness of skin is opened (Laceration and Skin loss).and Skin loss).

B) EtiologyB) Etiology::1) Abrasion(erosion) wound:1) Abrasion(erosion) wound: caused by friction caused by friction with rough surface, there is damage to skin with rough surface, there is damage to skin consisting loss of epidermis and portions of dermis. consisting loss of epidermis and portions of dermis. There is little bleeding, painful, heals slowly.There is little bleeding, painful, heals slowly.

2) Avulsion wound:2) Avulsion wound: there is complete there is complete separation of tissue caused by barbs.separation of tissue caused by barbs.

3) Incision wound:3) Incision wound: this type of wound is this type of wound is caused by sharp object characterized by caused by sharp object characterized by smooth regular wound edges.smooth regular wound edges.4) Laceration wound:4) Laceration wound: caused by barbs caused by barbs characterized by irregular edges created characterized by irregular edges created by tearing of tissue.by tearing of tissue.

5) Puncture wound:5) Puncture wound: caused by sharp pointed caused by sharp pointed object most dangerous type of wound.object most dangerous type of wound.

6) Penetrating wound:6) Penetrating wound: is a puncture wound is a puncture wound caused by sharp pointed object which caused by sharp pointed object which penetrate one of body cavities (Thoracic, penetrate one of body cavities (Thoracic, Abdominal, Pelvic, or joint cavity).Abdominal, Pelvic, or joint cavity).

These wounds we can Treated by:These wounds we can Treated by:Arresting the hemorrhage.Arresting the hemorrhage.Removed the foreign bodies and Removed the foreign bodies and

hair from wound.hair from wound.Cleaning the wound with sterilized Cleaning the wound with sterilized

water or normal isotonic solution.water or normal isotonic solution.Applying an antiseptic lotion or Applying an antiseptic lotion or

antibiotic powder to the wound.antibiotic powder to the wound.

Dressing wound with sterilized gauze or Dressing wound with sterilized gauze or cotton-wool to prevent contamination.cotton-wool to prevent contamination.

Regulated the wound edges to be clean Regulated the wound edges to be clean cut like incised wound.cut like incised wound.

Suturing the lips of the wound.Suturing the lips of the wound.Applying a protective pad and bandage.Applying a protective pad and bandage.Keeping the patient at rest.Keeping the patient at rest.Giving the antibiotics and nursing for Giving the antibiotics and nursing for

three days.three days.

These wounds we can Treated by:

Arrest of the circulation from the wound Arrest of the circulation from the wound towards the heart.towards the heart.

Washing the wound and compressing it from Washing the wound and compressing it from the periphery towards the center to flush out the periphery towards the center to flush out the poison.the poison.

Sucking the wound, which is without danger Sucking the wound, which is without danger when the mucous membrane is intact.when the mucous membrane is intact.

7) Poisoned wounds:7) Poisoned wounds: Caused by chemical or Caused by chemical or organic toxins such as mineral, venom, or organic toxins such as mineral, venom, or vegetable toxin.vegetable toxin.8) Pathogenic wounds:8) Pathogenic wounds: Caused by some virus, Caused by some virus, bacteria, …..etc. such as rabies, anthrax and bacteria, …..etc. such as rabies, anthrax and tuberculosis.tuberculosis.

Cauterization of the wound with one of Cauterization of the wound with one of the mineral acids or better by the hot iron.the mineral acids or better by the hot iron.

Irrigation of the wound with liquids which Irrigation of the wound with liquids which neutralize.neutralize.

Administration of Antiseptics, Antidote or Administration of Antiseptics, Antidote or Antibiotics.Antibiotics.

9) Ulcerating wounds:9) Ulcerating wounds: is superficial wound is superficial wound involving molecular destruction of tissue involving molecular destruction of tissue with cannot healing caused by repeated with cannot healing caused by repeated irritation, infection prevent healing or irritation, infection prevent healing or malignant tumors.malignant tumors.

10) Burns wounds:10) Burns wounds: caused by thermal, caused by thermal, scalding, friction, and freeze burns. These scalding, friction, and freeze burns. These causes are resulting simply forms of skin causes are resulting simply forms of skin necrosis. Burns are described by extent necrosis. Burns are described by extent percentage of body surface and depth of percentage of body surface and depth of tissue damage (first, second , and third tissue damage (first, second , and third degree).degree).

11) Contused wounds:11) Contused wounds: it is thick zone of it is thick zone of dead tissue, there is no breach in the dead tissue, there is no breach in the surface of the overlying skin, included surface of the overlying skin, included three degree:three degree:A) Contusions of the first degree:A) Contusions of the first degree: characterized by rupture of capillary characterized by rupture of capillary vessels in the skin and subcutaneous vessels in the skin and subcutaneous tissues and the formation of ecchymoeses.tissues and the formation of ecchymoeses.Treatment:Treatment:These are benign affections which undergo These are benign affections which undergo resolution, like all slight inflammatory resolution, like all slight inflammatory conditions, without any risk of conditions, without any risk of complication. They may be treated with complication. They may be treated with cold and astringent applications to arrest cold and astringent applications to arrest capillary hemorrhage, this lead to quick capillary hemorrhage, this lead to quick recovery.recovery.

B) Contusions of the second degree:B) Contusions of the second degree: characterized characterized by rupture of large vessels and production of a by rupture of large vessels and production of a hematoma.hematoma.

Treatment:Treatment: The case is recent, treatment The case is recent, treatment comprises:comprises:Cold water irrigation.Cold water irrigation.Astringent applications.Astringent applications.Compression with a pad and bandage at Compression with a pad and bandage at effected part.effected part.

In the long standing case, treatment In the long standing case, treatment comprises:comprises:

Incising the swelling at a dependent part.Incising the swelling at a dependent part.Evacuating its contents.Evacuating its contents.Treating its lining with an irritant Treating its lining with an irritant

antiseptic solution.antiseptic solution.The severe hemorrhage should be early The severe hemorrhage should be early

opening of hematoma before the ruptured opening of hematoma before the ruptured vessels are thrombosed it must be arrested vessels are thrombosed it must be arrested by plugging the cavity.by plugging the cavity.

Prognosis:it is undergo inflammation, Prognosis:it is undergo inflammation, granulation, and cicatrisation, and thus granulation, and cicatrisation, and thus remove the cavity.remove the cavity.

C) Contusions of the third degree:C) Contusions of the third degree: there is big there is big destruction of tissue, which may undergo destruction of tissue, which may undergo gangrene.gangrene.Treatment:Treatment:The moist warm antiseptic applications The moist warm antiseptic applications are due to restore the circulation in the are due to restore the circulation in the tissue damaged to prevent gangrene.tissue damaged to prevent gangrene.The antiseptic is added to counteract The antiseptic is added to counteract infection that may enter through abrasions infection that may enter through abrasions on the skin.on the skin.If the patient suffers from shock the usual If the patient suffers from shock the usual treatment for this condition.treatment for this condition.

A) Clean wound:A) Clean wound: is type of wound is type of wound that’s surgical created (under aseptic that’s surgical created (under aseptic conditions). It has minimal conditions). It has minimal contamination, it can be effectively contamination, it can be effectively removed.removed.B) Contaminated wound:B) Contaminated wound: when a when a wound had occurred since 6-12 hours wound had occurred since 6-12 hours is called contaminated wound. It is called contaminated wound. It divided into three classes:divided into three classes:

Contaminated class I:Contaminated class I: there is little there is little bacterial proliferation.bacterial proliferation.

C) Degree of contaminationC) Degree of contamination::

Contaminated class II:Contaminated class II: there is large there is large bacterial proliferation, but bacteria bacterial proliferation, but bacteria still in lag phase can’t invade tissue.still in lag phase can’t invade tissue.

Contaminated class III:Contaminated class III: it called it called infected wound, is the wound that infected wound, is the wound that had occurred since more than 12 had occurred since more than 12 hours characterized by presence of hours characterized by presence of necrotic tissue or suppuration, necrotic tissue or suppuration, sometimes accompanied by sometimes accompanied by systemic reaction (fever, anorexia, systemic reaction (fever, anorexia, …. etc.)…. etc.)