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Types of Wounds

1.) Lacerations Injury where tissue is cut or torn. For treatment, tissue is first cleansed of any blood clots and foreign material, dbribed and irrigated. Local anesthetic is administered and atraumatic technique of wound closure is employed, where wound margins are realigned with careful regard to prevention of any further crush injury to tissues. Sterile dressings are applied and immobilization is recommended for complex extremity wounds. 2.) Abrasions Injury where a superficial layer of tissue is removed, as seen with 1st degree burns. The wound is cleansed of any foreign material, sometimes employing a scrub brush to prevent traumatic tattooing by dirt and gravel, and should be performed within the first day of injury. Local anesthetic can be used for pain, however treatment of the wound is non-surgical, using moist dressings and a topical antibiotic to protect the wound and aid healing. 3.) Contusions Injuries resulting from a forceful blow to the skin and soft tissue, however leaving the outer layer of skin intact. These injuries generally require minimal care as there is no open wound. However, contusions should be evaluated for possible hematoma deep to the surface or other tissue injuries that may indicate more severe morbidity. An expanding hematoma can damage overlying skin and demands evacuation. 4.) Avulsions Injuries where a section of tissue is torn off, either partially or in total. In partial avulsions, the tissue is elevated but remains attached to the body. A total avulsion means that the tissue is completely torn from the body with no point of attachment. In the case of a partial avulsion where the torn tissue is still well-vascularized and viable, the tissue is gently cleansed and irrigated and the flap is reattached to its anatomical position with a few sutures. If the torn tissue is non-viable, it is often excised and the wound closed using a skin graft or local flap. In the case of a total avulsion, the tissue is often very thick and demands debulking and defattening methods before it can be regrafted. Major avulsions describe amputation of extremities, fingers, ears, nose, scalp or eyelids and require treatment by a replant team.

Management

Wound, sewn with four stitches

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. If there is a delay in treatment and the laceration occurred more than 6-24 hours before evaluation, it may be preferable to heal by secondary intention, due to the high rate of infection associated with delayed closure. Minor wounds, like bruises, will heal on their own, with skin discoloration usually disappearing in 12 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. Most abrasions tend to have an overall better appearance post-healing when kept moist for about a week with an ointment, such as aquaphor healing ointment or vasoline. Puncture woundsmay 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. [edit]Cleaning For simple lacerations, cleaning can be accomplished using a number of different solutions, including tap water, sterile saline solution, or an antiseptic solution, such as hydrogen peroxide. Infection rates may be lower with the use of tap water in regions where water quality is high.[1] Evidence for the effectiveness of any cleaning of simple wound however is limited.[1]Cleaning of a wound is also known as wound toilet.[2] [edit]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. [3] Thus some healthcare providers may delay closure while others may be willing to immediately close up to 24 hours after the injury.[3] A single study has found that using clean non sterile gloves is equivalent to using sterile gloves during wound closure.[4][5]

If closure of a wound is decided upon a number of techniques can be used. These include bandages, a cyanoacrylate glue, staples, andsutures. Absorbable sutures have the benefit over non absorbable sutures of not requiring removal. They are often preferred in children.[6]Buffering the pH of lidocaine makes the freezing less painful.[7] [edit]Dressings The effectiveness of dressings and creams containing silver to prevent infection or improve healing is not currently supported by evidence.[8] Egg Oil has been used in treating wounds and injuries. Ambroise Par used a solution of egg yolk, oil of roses, and turpentine for war wounds, an old method that the Romans had discovered 1000 years before him. He published his first book 'The method of curing wounds caused by arquebus and firearms' in 1545. Egg Oil is a natural emollient, and may be used externally on burn wounds,[9] where it reduces pain and promotes re-epithilisation while minimising scars[10]. It has been used effectively against burns in rural Ethiopia[11]. [edit]Antibiotics Most clean open wounds do not require any antibiotics unless the wound is contaminated or the bacterial cultures are positive. Excess use of antibiotics only leads to resistance and side effects. All open wounds should be cleaned at least twice a day with warm water and soap. Once the wound is cleaned, it should be covered with moist gauze. This should be followed by application of dry gauze and then the wound covered with a bandage. The purpose of a wet to dry dressing allows the bandage to adhere to dead tissue performing a mechanical debridement when removed.This allows new healthy skin to grow and prevents debris from collecting. When the wound is clean, it may be closed with a skin graft. No wound is ever closed if it is suspected to be infected.[12] [edit]Complications Bacterial infection of wound can impede the healing process and lead to life threatening complications. Scientists at Sheffield University have identified a way of using light to rapidly detect the presence of bacteria. They are developing a portable kit in which specially designed molecules emit a light signal when bound to bacteria. Current laboratory-based detection of bacteria can take hours or even days.[13] When to Call the Doctor

Blood spurting from a wound, even if controlled initially by first aid. Bleeding that persists despite all efforts to control it. An incised wound deeper than the outer layer of skin. Any laceration, deep puncture, or avulsion. Severed or crushed nerve, tendon, or muscle.

Laceration of the face or other parts of the body where scar tissue would be noticeable after healing. Skin broken by a bite, human or animal. Heavy contamination of a wound by soil or organic fertilizer (manure). Foreign object embedded deep in the tissue. Foreign matter in a wound, not possible to remove by washing. Any other open-wound situation in which there is doubt about what to do.