Types of Wounds

A wound is an injury or damage to live tissue caused by a variety of factors. Based on nature – two main types: Open wound and Closed Wound

WOUND

In simple terms, wound refers to a break or disruption in the skin or other biological body tissues caused by either injury, trauma or surgery. Let’s try to understand causes and types of wound in detail to expand our knowledge horizons:

Cause of Wounds

• Mechanical agents: Agents directly tend to damage tissue integrity. Mechanical forces acting on a tissue can result in a wound. A Contusion occurs when a mechanical force works on a tissue and causes harm with the wound staying closed whereas a Laceration occurs when a mechanical force acts on a tissue and causes an open wound.
• Chemical agents: Harsh chemicals, such as concentrated acids or powerful alkalis (bases), as well as poisons from venomous snake or insect bites that can cause tissue wounds.
  Additionally, few drugs, particularly systemic corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), as well as chemotherapy agents, can delay the wound healing process.
• Radiant agents: X-rays, atomic energy, heat, high-voltage electricity, and extreme cold are all examples of radiation. Tissue necrosis (premature cell death) can be caused by any of these factors.
• Biological agents: Organisms such as microbes (fungi/bacteria do not produce wounds directly; instead, they infiltrate an existing wound, causing widespread tissue necrosis and expanding it. Toxins (like bacterial toxin), which assist infections breakdown tissue and can cause hypersensitive reactions, are utilised by pathogens. Furthermore underlying medical conditions (diabetes, immunological conditions) disrupt the normal healing process.

Classifications of Wounds based on their nature

Wounds are usually categorised based on the type of damage they cause and by the mechanism by which they occur.

• Closed wounds
• Open wounds

Closed Wound: Refers to injuries in a scenario where skin remains intact, whereas the underlying tissues are damaged. 

Different types of closed wounds

• Contusions (or Bruises): Refers to injuries where small blood vessels beneath the skin rupture, causing localised bleeding as well as discolouration. The skin remains unbroken, but the affected portion/area may swell and become tender. For instance – Injuries from blows, collisions, or falls.
• Haematomas: Pool of blood outside of blood vessels due to damage to larger blood vessels. Can differ in size or dimensions. May cause swelling or pain. For instance – Larger or deeper contusions, like those resulting from trauma or surgery.
• Sprains: Injuries to ligaments (the connective tissues between bones) caused by overstretching or tearing. Sprains majority of times result in pain, swelling, and bruising but do not involve a break in the skin. For instance – Ankle sprains, wrist sprains, or knee sprains.
• Strains: Injuries to muscles or tendons (the connective tissues between muscles and bones) caused by too much stretching or tearing. Strains can cause pain, swelling (localised enlargement), along with difficulty moving the affected muscle. For instance – Muscle strains from too much or sudden movements.
• Internal Injuries: Refers to damage to internal organs or tissues without external signs of injury. These injuries may result from blunt trauma or impact and can be serious, requiring medical intervention. For instance – Internal bleeding, organ damage resulting from car accidents or falls.

Open Wound: Refers to the wounds with exposed underlying tissue and open to the outside environment, for instance, penetrating wounds.

Unlike the case of open wounds, closed wounds do not break the skin’s surface, which means there is no direct contact to the outside environmental conditions. Despite the lack of visible disruption, closed wounds can still be crucial and need careful assessment and management to prevent complications and enhance the process of recovery.

Different types of open wounds

• Laceration
• Abrasion
• Avulsion
• Perforations or Penetrating wounds
• Punctured wound

• Abrasions:  Occurs as a result of minor contact or scraping the skin against a rough surface, predominantly through the action of falling over. Kids tend to get them when falling over during outdoor activities, like riding a bike/bicycle or playing football. They usually only affect the epidermis (the outer layer of skin). However, these wounds can become more severe in certain cases where the abrasions affect a wide portion of the body or are deeper into the skin tissue.
• Laceration: Caused by skin tissue tearing from an external force. Due to the high level of force, the edges of the skin around the wound are not as smooth as incisions and therefore can lead to very prominent scarring in a scenario where proper wound care routine is not followed.
  Do you know? Lacerations heal extremely slowly in comparison to an incision wound because the tear in the skin tissue is much more jagged. They can usually impact the deeper tissues within the body like: bones, blood vessels, muscles, ligaments, tendons, ligaments, nerves, along with other internal organs. These wounds typically affect the portions of the body that are very proximity to the bone, like knees, elbows, shins, forehead and skullcap.
• Incision: Caused when a razor sharp object inflicts the skin with a clean cut. A very predominant example of an incision wound would be a surgical cut for an operation on the body. Common causes of incision wounds can be from kitchen knives, scissors, broken glass pieces and any other accessible sharp objects through doing day to day activities. Usually, incision wounds heal much quicker than other types of wounds due to the smoother skin edges around the cut. This means scarring from deep incision wounds is less prominent in comparison to other wound types.
• Puncture: Occurs when a razor sharp object goes deep inside the skin. They can be caused by unknowingly stepping on an upright nail or needle. Puncture wounds are deeper and typically more narrow than incision wounds, and often can cut through the underlying tissues depending on the size of the object. Puncture wounds typically close rapidly as they’re smaller on the exterior, however they can lead to internal infections like tetanus.
• Avulsion: They are more severe injuries in which the skin is entirely separated from the tissue beneath. Avulsions usually occur during major road accidents or when the body interacts with an object/entity that is moving at dangerously high velocity. An avulsion injury would require prompt surgical treatment for chances of recovery on the torn tissue.

Understanding the distinct types of wound is important for preventing complications and enhancing rapid healing.