3. Definition
A wound is a break in the integrity of the skin or
tissues often, which may be associated with
disruption of the structure and function
4. Classification of wounds
There are various classification
1)Rank and wakefield classification
a.Tidy wounds: they are wounds like surgical incision and
wounds caused by sharp objects ,these are clean and healthy
and healing occurs by primary intention
b.Untidy wounds:they are due to crushing
,avulsion,devitalized injury here wound dehiscence ,
infection and delayed healing are common further secondary
suturing , skin graft or flap may be needed
5. Classification based on the type of the wound
Clean incised wound: tidy ,simple,clean cut wound with
linear cut edges
Lacerated wound: it has ragged edges with some part of
the tissue getting devitalized
Bruise or contusion: blow or blunt forces to the skin and
tissues underneath wher in blood vessels or cappillaries
are damaged underneath.
Haematoma:localized collection of blood after blunt
trauma or after surgery
Abrasion: it is superficial
injury(scratchgrazepressurecontact) and is due shearing
of the skin where surface is rubbed off.
6. Other types are:penetrating wounds, traction and
avulsion injuries ,crush injury, gunshot injuries , injuries
to bones and joints ,closed blunt injury
7. Classification based on thickness of the
wound
Superficial wound: involves epidermis + dermal papillae
Partial thickness: epidermis + deep dermis
Full thickness: entire skin with subcutaneous fat
Deep wounds: involves fascia,muscles and deeper
structures
Complicated wounds: involves injury to nerves and vessels
Penetrating wound
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9. Classification based on time elapsed
Acute wounds are defined as those that progress through
normal phase of healing and typically shows signs of
healing in less than 4 weeks
Chronic wound are those wounds where healing does not
occur within expected period accordind to its aetiology
and localization
11. Normal wound healing
this is variously described as taking place in three or four
phases
1) Haemostatic phase
2) The inflammatory phase
3) The proliferative phase
4) The remodelling phase(maturing phase)
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19. Wound healing factors
General factors
Age, obesity, smoking ,alcohol ,stress
Malnutrition, zinc, copper, manganese
Vitamin deficiency ( vit A,C)
Anaemia,hypoxia
Malignancy
Uraemia
Jaundice
Diabetes , metabolic diseases
HIV and immunosuppressive diseases
Steroids and cytotoxic drugs
Neuropathies of different causes
20. Local factors
Infection
Presence of necrotic and foreign body
Poor blood supply
Venous or lymph stasis
Tissue tension
Haematoma
Large defect or poor apposition
Recurrent trauma
X ray irradiated area
Site of wound-wound over the joints and back has poor healing
Underlying diseases like osteomyelitis and malignancy
Mechanism and type of wound-incisedlaceratedcrushavulsion
Tissue hypoxia ;locally reduces macrophage and fibroblast activity
21. Wound closure and healing
Primary intention
Wound edges are opposed
Normal healing
Minimal scar
Secondary intention
Wound left open
Heals by granulation contraction and epithelialisation
Increased inflammation and proliferation
Poor scar
Tertiary intention(also called delayed primary
intention)
Wound initially left open
Edges later opposed when healing conditions favourable
