How do different types of traumatic open wounds differ. What are the key characteristics of abrasions, excoriations, skin tears, avulsions, lacerations, and punctures. How can healthcare professionals accurately identify and treat various open wounds.

Understanding Traumatic Open Wounds: A Comprehensive Guide

Traumatic open wounds are injuries that disrupt the integrity of the skin and underlying tissues due to mechanical forces. These wounds result from brief but forceful contact with objects or surfaces, leading to various types of tissue damage. Healthcare professionals must be able to differentiate between these wound types to provide appropriate treatment and care.

In this comprehensive guide, we’ll explore six common types of traumatic open wounds, their characteristics, and key factors for identification and management. By understanding the nuances of each wound type, healthcare providers can improve patient outcomes and reduce the risk of complications.

Abrasions: Superficial Skin Damage from Friction

Abrasions are among the most common types of traumatic open wounds. They occur when the skin is scraped against a rough surface, resulting in superficial damage to the epidermis and sometimes the dermis.

Key Characteristics of Abrasions:

• Appear as lines of scraped skin with tiny spots of bleeding
• Can vary in size from small scrapes to large areas of “road rash”
• Always partial thickness, affecting the epidermis and sometimes the dermis
• Typically caused by friction against rough surfaces like pavement or gravel

How can healthcare providers distinguish abrasions from other wound types? Abrasions are characterized by their superficial nature and the presence of multiple tiny bleeding points. Unlike deeper wounds, abrasions do not penetrate through the entire dermis, making them less severe but still requiring proper care to prevent infection and promote healing.

Excoriations: Linear Scratches on the Skin Surface

Excoriations, commonly known as scratches, are similar to abrasions but have distinct characteristics that set them apart. These wounds are caused by sharp objects or fingernails that create linear marks on the skin surface.

Identifying Excoriations:

• Linear appearance due to the mechanical force that caused them
• Partial thickness, affecting the epidermis and sometimes the dermis
• Often caused by cat claws, fingernails, or other sharp objects
• Can be mistaken for denudation in cases of prolonged moisture exposure

Why is it important to distinguish excoriations from denudation? Excoriations are traumatic wounds, while denudation is the loss of epidermis due to prolonged exposure to moisture and friction. This distinction is crucial for proper documentation and treatment, especially in cases of Moisture Associated Skin Dermatitis (MASD).

Skin Tears: A Growing Concern in Vulnerable Populations

Skin tears are a type of traumatic wound that primarily affects older adults and infants due to their more fragile skin structure. The International Skin Tear Advisory Panel (ISTAP) defines skin tears as wounds caused by shear, friction, or blunt force that result in the separation of skin layers.

ISTAP Classification of Skin Tears:

1. Type 1: No skin loss, with a linear or flap tear that can be repositioned
2. Type 2: Partial skin loss, with a partial flap that cannot be fully repositioned
3. Type 3: Total flap loss, exposing the entire wound bed

Why are skin tears a growing concern in healthcare settings? With an estimated 1.5 million instances of skin tears occurring in hospitals and long-term care facilities annually, there is an increasing focus on prevention and proper management. Healthcare providers must be aware of the risk factors and implement strategies to protect vulnerable patients from these painful and potentially complex wounds.

Avulsions: Severe Tissue Separation and Loss

Avulsions, also known as “degloving” injuries, are among the most severe types of traumatic open wounds. These injuries occur when tissue is forcefully torn away from the body, resulting in significant tissue loss and heavy bleeding.

Characteristics of Avulsions:

• Deep wounds that extend into subcutaneous tissue, muscle, or bone
• Marked by heavy, rapid bleeding and noticeable tissue absence
• Caused by extreme force or trauma
• Require immediate medical attention and often surgical intervention

How do avulsions differ from skin tears? While both involve tissue separation, avulsions are significantly deeper and more severe. Skin tears typically affect only the epidermis and dermis, while avulsions can involve subcutaneous tissue, muscle, and even bone. This distinction is crucial for determining the appropriate treatment approach and assessing the potential for complications.

Lacerations: Jagged Tears in the Skin and Underlying Tissues

Lacerations are torn or jagged wounds characterized by edges that do not align easily. These injuries are often caused by blunt force trauma, such as falls, collisions, or impacts with hard objects.

Key Features of Lacerations:

• Irregular, jagged wound edges
• Can be shallow or deep, depending on the force of impact
• Often occur over bony prominences, such as the scalp
• May involve minimal to extensive tissue damage and varying degrees of bleeding

What factors influence the severity of lacerations? The depth and extent of tissue damage in lacerations can vary widely depending on the force of impact, the location of the injury, and the presence of underlying structures. Healthcare providers must carefully assess these factors to determine the appropriate treatment approach, which may range from simple wound closure to more complex surgical interventions.

Puncture Wounds: Deep, Narrow Injuries with Hidden Risks

Puncture wounds are caused by sharp objects that penetrate deeply into the skin and underlying tissues. These injuries are characterized by their depth relative to their width and can pose significant risks despite their often innocuous appearance.

Identifying and Assessing Puncture Wounds:

• Deep, narrow wounds caused by sharp objects like nails or needles
• Often deeper than they are wide
• May have minimal external bleeding but significant internal bleeding and discoloration
• High risk of infection due to the introduction of bacteria into deeper tissue layers

Why are puncture wounds particularly concerning for healthcare providers? Despite their small surface appearance, puncture wounds can introduce bacteria deep into the body, increasing the risk of serious infections. Additionally, there is always the possibility that the puncturing object may have broken off and remained within the tissue, requiring careful assessment and potentially imaging studies to ensure complete removal.

Complex Wound Presentations: When Multiple Types Coexist

In many cases of traumatic injury, patients may present with a combination of wound types. This complexity can make accurate assessment and treatment planning challenging for healthcare providers.

Strategies for Assessing Complex Wounds:

• Conduct a thorough visual and physical examination of the entire affected area
• Document the characteristics of each distinct wound type present
• Consider the mechanism of injury to understand potential hidden damage
• Use advanced imaging techniques when necessary to assess deeper tissue involvement

How can healthcare providers effectively manage complex wound presentations? A systematic approach to wound assessment is crucial. By carefully documenting each wound type and its characteristics, providers can develop a comprehensive treatment plan that addresses the specific needs of each injury component. This may involve a combination of wound closure techniques, infection prevention strategies, and ongoing monitoring for potential complications.

Understanding the nuances of traumatic open wounds is essential for healthcare providers across various settings. By accurately identifying and assessing these different wound types, clinicians can provide targeted, effective care that promotes optimal healing and reduces the risk of complications. As wound care continues to evolve, staying informed about the latest classification systems, assessment techniques, and treatment approaches will be crucial for delivering high-quality patient care.

Traumatic Open Wounds: Let’s Define the Types

Learn the difference between the types of open wounds caused by trauma.

Traumatic open wounds involve a disruption in the integrity of the skin and underlying tissues caused by mechanical forces. In other words, these wounds are caused by brief but forceful contact with another object or surface. Types of traumatic wounds include abrasions, lacerations, avulsions, punctures, and excoriations. 

Differentiating the types of traumatic open wounds involves noting the characteristics of the tissue, as well as the nature of the mechanical force that caused it.

Below, we outline six acute, traumatic open wounds that are commonly confused.

Abrasion

Abrasions result from shearing of the skin by a rough surface. They appear as lines of scraped skin with tiny spots of bleeding.

Their size can vary from the common scraped knee to road rash over a large area of the body.

Abrasions are always partial thickness, however. You’ll see skin loss through the epidermis and sometimes into the dermis, but not through the entire dermis.

Excoriation

In a layperson’s terms, excoriation is called a scratch. It is similar to abrasion in that it is a partial thickness shearing of skin.

With excoriation, however, the erosion is even more noticeably linear (line-like) because of the mechanical force that caused it.

Light contact with cat’s claws, for example, leads to excoriation, whereas brushing or dragging the skin across a rough, flat surface such as pavement leads to abrasion.

Many clinicians mistakenly use the term excoriation to refer to denudation, which is the correct term for the loss of the epidermis that’s caused by prolonged exposure to body fluids such as urine, feces and exudate plus friction.

When assessing a case of Moisture Associated Skin Dermatitis (MASD), document the areas of erosion as denuded, not excoriated.

Skin tear

The International Skin Tear Advisory Panel (ISTAP) defines skin tears as follows:

A skin tear is a wound caused by shear, friction and/or blunt force resulting in separation of skin layers. A skin tear can be partial thickness (separation of the epidermis from the dermis) or full thickness (separation of both the epidermis and dermis from underlying structures).

Skin tears occur principally on the extremities of older adults because of changes in the skin’s structure that make it more fragile, such as flattening of the junction between the dermis and epidermis. Infants are more vulnerable to skin tears as well.

The ISTAP has developed a skin tear classification system:

• Type 1: No skin loss. Linear or flap tear that can be repositioned to cover the wound bed.
• Type 2: Partial skin loss. Partial flap loss that cannot be repositioned to cover the wound bed.
• Type 3: Total flap loss. Total flap loss exposing entire wound bed.

Because there are a reported 1.5 million instances of skin tears among patients within hospitals, long-term care facilities and other settings, there are global efforts to promote skin tear prevention within these institutions.

Efforts include recommending environmental modifications and raising awareness of the proper care for aging and immature skin.

Avulsion

A skin avulsion, also called “degloving,” occurs when tissue is not just separated but forcefully torn away from the body. It is marked by heavy, rapid bleeding and a noticeable absence of tissue.

Avulsions go deep into the subcutaneous tissue or further (muscle or bone).

The key difference between skin tears and avulsions is depth, which is directly related to the level of force applied.

WCEI Clinical Instructor Bill Richlen, PT, WCC, DWC, explains, “Skin tears can be both full or partial thickness. However, in the case of a skin tear, the full thickness ones are generally only deep enough to expose the subcutaneous tissue.”

Laceration

Lacerations are torn or jagged wounds with edges that do not readily line up. Tear lacerations tend to be caused by blunt force trauma, such as a blow, fall or collision.

A blunt injury that rips open the skin over a bony prominence, such as the scalp, is one example. There may be little or profuse bleeding and minimal or extensive tissue damage.

Puncture

Puncture wounds are caused by a sharp object that deeply penetrates the skin, such as a nail. Generally, puncture wounds are deeper than they are wide.

Typically, there’s little bleeding around the outside of the wound and more bleeding inside, causing discoloration. Puncture wounds may not seem serious but, due to the introduction of germs into the deeper layers of skin, they may easily become infected. There is also the risk that the puncturing object may break off and remain within the skin layers.  

Open wounds can mix and mingle

Note that multiple open wound types can result from a single source of trauma.

A bite from a large dog can cause a crush injury, which may lead to lacerations, puncture wounds and avulsion.

By using the correct terms for open wounds, you can communicate clearly and efficiently with your team, giving them an accurate understanding of the wound being treated.

As with any open wound, traumatic open wounds are at risk of infection. If a traumatic injury wound develops signs of infection such as drainage, odor, redness, warmth, swelling, or the patient develops fever, nausea, or chills, the patient should be evaluated by a healthcare professional. Traumatic wounds should also be evaluated by a healthcare professional if the patient is elderly, very young, immunocompromised, or at risk such as diabetic.

If you’re interested in expanding your knowledge of wound care, networking with colleagues, or seeing the latest wound care products and technology, register for the Wild on Wounds (WOW) conference September 13–16 in Hollywood, Florida.

Editor’s Note: This post was originally published in December 2019 and has been updated with new content. 

Tara Call Triplett, RN, WCC, CHFN

Tara Call Triplett has over 20 years of experience as a registered nurse and is the founder of Call to Health Communications. She is nationally certified in both wound care and heart failure. Triplett currently leads an amazing team of clinicians at an award winning outpatient wound care clinic. She has a passion for teaching and mentoring the next generation of wound care clinicians.

Orthopedic Specialists Treating Lacerations

A laceration implies a torn or jagged wound that varies in length. If a laceration is longer than a ½  inch or deeper than a ¼ inch, it is best to have it checked out, as it may require stitches, sutures, or staples to completely close and safely heal a laceration.

Is there a difference between a cut and laceration?

A cut is a skin wound with a separation of connective tissue. None of the skin is missing, but it is separated. A laceration implies a torn or jagged wound that is usually deeper or wider and often needs stitches. 

How do you know when medical care is necessary?

If you have any doubts at all, it’s always a good idea to play it safe, and seek medical attention for your laceration, especially if you cannot stop the bleeding, the wound edges are separated, or you cannot clean the wound adequately enough for it to heal properly. Plus, with any laceration, there is always the risk of infection, because sharp objects that usually cause them may be contaminated with bacteria or debris. If that is the case, your doctor will give you a tetanus vaccination or booster shot along with treatment.

Also, patients who have circulation problems or diabetics should always seek medical attention for open wounds, as they may require additional treatment to prevent infection.

Why should you see orthopedic specialists for lacerations?

You should see an orthopedic specialist for lacerations, because some lacerations may involve tendon and nerve damage. Sometimes these lacerations aren’t always immediately noticeable and can take days or weeks for such nerve or tendon damage to show up. Orthopedic specialists would be more apt to catch these and provide the immediate care you need. 

Orthopedic specialists can also treat hand injuries that involve fingertip and nail bed lacerations. If these aren’t treated properly, these injuries can lead to hand function problems, permanent deformities, or even disability, as these are sensitive areas where bone and nerves are affected when exposed. 

Come see us for quick-care orthopedic injury treatment for cost-effective care at medical office rates, not hospital rates. Don’t let lacerations become complications.

How do you know if you need stitches?

There are four basic considerations as to whether or not you may need stitches:

• Depth. Is the wound deep enough to see the subcutaneous tissue (yellowish fatty tissue)?
• Width. Can the wound be pulled closed easily?
• Location. Is the wound in a location of the body that stretches and moves a lot (e.g., a wound on a calf)?
• Tetanus vaccination. How long has it been since you had your last tetanus vaccination? It is recommended that you have one every 10 years. If you need one, especially after having a laceration, go see a doctor and have your wound evaluated for stitches.

What are the benefits of getting stitches?

Getting a laceration stitched is a good idea for several reasons:

• Stops bleeding
• Promotes quicker healing
• Keeps bacteria out of the wound
• Prevents infection
• Protects underlying tissue
• Reduces scarring

What types of exams and tests are done for lacerations?

During your visit, your doctor will ask you several questions about your injury including

• When did it happen?
• How did it happen?
• Do you have any problems with weakness or numbness?
• Do you have any allergies to adhesive tapes?
• Do you have any pre-existing medical conditions, such as circulation problems or diabetes?

Your physical exam will include

• Separating the edges and looking at the wound
• Testing nerve, artery, and muscle function
• Checking for objects in the cut (such as embedded glass or wood)
• Examining your overall condition (such as whether you are pale from blood loss or anxiety)

If foreign objects or an underlying broken bone is suspected, an X-ray may be ordered.

How do you treat a laceration?

Treatment for a laceration usually depends on how deep the cut is, but generally, the treatment process includes:

• Taking steps to stop the bleeding with direct pressure or the use of a blood pressure cuff
• Applying Medication to numb the area
  • Topical medicine
  • Direct injection of anesthetic into the wound
  • Injection into a regional nerve (nerve block)
• Cleaning the wound
  • Washing the skin with soap and water
  • Removing crusted blood with diluted hydrogen peroxide
  • Irrigating with saline at the wound site under high pressure to reduce bacterial contamination
• Repairing the wound
  • Minor cuts can be closed with special adhesive tapes (Steri-Strips) or tissue glue
  • Deeper cuts may need stitches to repair deep structures
• Applying bandages
  • Telfa or Vaseline gauze that doesn’t stick to your cut
  • Pressure bandages or splints that provide needed surface pressure or keeps an injury immobile

Is follow-up care required for a laceration?

If you have sutures placed, your doctor may recommend that you have the wound checked 1 or 2 days after treatment, especially if there is a higher than 5 percent chance of infection or if changing the bandage is difficult.

Stitches may be removed at your doctor’s office anywhere between 4 and 14 days later. The actual time period depends on the location of the injury. For example, facial stitches are removed after 4 days and no later than 7 days, because healing occurs faster in this location of the body. Sutures in your hand may be left in 14 days or more because of slower healing and greater tension on the wound.

What can you do to minimize scarring?

It is normal for a scar to look red and swollen after suture removal, and it can take up to 1 year for a scar to fade. In the meantime, there are several things you can do to minimize the possibility of scarring:

Infected wounds tend to scar more, so

• Keep an eye out for redness, swelling or other signs of infection and see a doctor
• Keep the wound covered and clean
• Avoid sun exposure as newly healed tissue burns more easily

Before consulting a specialist for scar revision, wait a year for the scar to fade.

Contact Us

At Summit Orthopaedics, we treat lacerations on all areas of the body including the fingers, feet, arms, and face. Call us at (503) 850-9940 to schedule an appointment. For Immediate Care, you may call our subsidiary Go To Ortho at (503) 850-9950.

traumatologist appointment in Krivoy Rog

June 13, 2021

Household injuries: treatment in Kryvyi Rih Household injuries are cases of injuries and injuries to limbs or other parts of the body at home, on the street, in the yard. Cuts, bruised limbs, torn ligaments and muscles, as well as dislocations and fractures occur everywhere, and therefore it is necessary to know how to protect yourself from injury and provide first aid if an accident occurs. We recommend that you immediately make an appointment with a traumatologist in Krivoy Rog if you get a burn, cut, bruise!

Unfortunately, one of the leaders in statistics is child injuries. The figures say that about 35% of cases are due to bruises, up to 23-24% for fall injuries, up to 20% for tissue damage with sharp objects, and about 15-18% for burns. Often, the situation is uncontrollable, since young children do not always understand what is possible and what is not, children aged 7-10 years old are extremely inquisitive, and children 11-14 years old are often unsupervised, and while playing on the street they arrange not quite deliberate competitions, they are ready to climb trees on a dare, they like to spend time at construction sites.

Hundreds and thousands of cases of falls and fractures, banal games of war games and traumatization of the eyes and face during “staging battles”. It is impossible to predict where and when grief will happen, but you can always carry out preventive work with the child in time, talk about the need to be careful, and not allow the influence of bad company.

What is domestic injury

We intersect with this concept every day, even within our own family. Getting minimal injuries, we do not pay attention to them, depending on the severity. Hitting your little finger on a table leg, cutting yourself or getting burned in the kitchen is already standard. A cry of surprise, a stingy tear, cold water to relieve pain or a piece of ice from the freezer … and that’s it. Sometimes, this is really enough, but what if the injuries are more serious? Let’s talk about them in more detail!

Ordinary domestic injuries overtake us in an apartment, a private house, in the yard during a walk or while working on our own site. We propose to conditionally divide injuries according to severity, as they are seen by all people, and not purely medical workers!

Shallow cut: treatment, first aid

Cuts on arms and legs: first aid Shallow cut with a knife or glass, damage to the skin from broken dishes when a glass or cup was crushed in the hand, cut with paper. Unpleasant, but not fatal, right? Despite this fact, first aid is needed, which will exclude infection and more complex consequences, and also help the body recover faster.

First aid for minor cuts! It is necessary to wash the wound if it is contaminated, gently blot the blood, dry the wound with a sterile bandage or gauze, and treat the edges of the cut with an antiseptic, brilliant green or iodine, preventing these funds from getting on damaged tissues. After that, you need to apply a clean bandage and stick it with a medical plaster. Contacting a doctor for bandaging and treatment control, additional manipulations, at your own discretion!

What to do if you get a deep cut

This kind of damage can happen at home, while doing repairs or cleaning your own yard. A cut with a sharp knife, a tin can, a cut with glass or a construction cutter, power tools.

Deep cuts on the arms, legs or torso are damage not only to the skin, but also to internal tissues, blood vessels and muscle fibers, ligaments and tendons. It is important to quickly stop the bleeding, for which the wound is clamped with a clean bandage and pressed. If the limb is damaged, you need to raise its top. Do not crush your arm or leg by applying a tourniquet, this often leads to additional injuries and complex consequences. It is better to immediately seek help, call an ambulance or, in case of successful stopping of bleeding, drive to a medical facility where a specialist will examine, treat the wound and perform suturing.

First aid for lacerations

Lacerations: treatment, sutures, dressingThis type of injury occurs when organic tissues come into sharp contact with objects, with the presence of additional efforts. An example would be a hand cut with a hacksaw for wood, a lacerated wound from a grinder disk at high speeds, when a person stumbles and falls on a glass container, a stack of dishes, or when he steps with his bare foot on a stone, glass.

Rupture – damage with jagged edges, of varying depth and with varying degrees of tissue damage. Up to 80% of people think so. For physicians, lacerations represent a slightly different type of damage, which is associated with rupture of the skin and mucous membranes as a result of external influences that are stronger than the ability of the tissue to stretch. Roughly speaking, the skin and subsequent tissues burst on contact with solid objects. The injury can be serious – from a puncture of the skin to damage to muscles, blood vessels and nerves.

Quickly stop the bleeding, apply a sterile dressing and go to surgery or the nearest emergency room for antiseptic treatment, cleaning and washing, excision of non-viable tissues, suturing and draining!

Puncture wounds

The complexity and severity of the injury is difficult to assess. Of course, if you prick your finger with a needle or step on a nail, the problem is understandable. But traumatologists cite numerous other cases as an example. Often, experts talk about piercing a finger with a skewer, about a more difficult puncture of a leg with a skewer when stringing meat, piercing palms. In the practice of doctors, there are cases of deep tissue damage when a person steps on or falls on a pitchfork, sits on a knife or broken glass. Deep injuries are not uncommon for builders who step on nails while roofing or laying floors.

In severe cases, call an ambulance and take the victim to the nearest medical center. Whenever possible, the objects of injury are not removed from the tissues in situ. The extraction is performed by doctors who have the opportunity to immediately stop the bleeding that has arisen, to proceed with the recovery operation, because the vessels and nerves, veins and arteries are often damaged.

Domestic injuries: video interview with a Mediton Clinic traumatologist

Cuts, lacerations and puncture wounds are only a small number of the total number of possible injuries. And in the next article, we give examples of them, based on cases of patients visiting our traumatology department.

Pay attention to the safety rules when working with power tools, be careful when decorating your own home or cleaning your summer cottage, remember to take care of yourself even during banal cooking or washing dishes. This will not protect you 100% from adverse events, but it will seriously limit them and significantly reduce the possible degree of damage in the event of negative situations!

Assistance in case of domestic injuries Book an appointment with a traumatologist in Krivoy Rog by phone (098) 530-60-40: contact center, viber. Book online through your personal account on the clinic website!

Pay attention:

Winter injuries: first aid and prevention

Treatment of burns, first aid

Treatment of sports injuries

Scratches, abrasions, cuts, lacerations – we can “get” all this even in our own apartments. And in the country, the risk grows exponentially. At the height of the season, we talk about how to properly treat wounds and when to see a doctor.

So, let’s start with when exactly you need to seek the help of specialists:

1. When a small child got hurt.

2. When bitten by animals – not only dogs, but also foxes, hedgehogs, rodents. This is very important, since the animal can be a carrier of rabies, and only timely medical care can save the victim.

3. If the wound was caused by a dirty or rusty object and you have not had a tetanus shot in the last 5 years.

4. For cuts and lacerations, if the depth of the wound is deeper or more than 1. 5 cm.

5. If there is bleeding of a pulsating nature.

6. If wounds and deep cuts on the hands, face, neck, head.

7. When the blood does not stop for more than 20 minutes.

8. When there are several wounds.

9. If a high temperature has risen and persists after the injury.

10. If the victim has dizziness and nausea.

11. If there is inflammation, the wound does not heal well.

How to treat wounds

Prepare to treat the wound: wash your hands and apply hand sanitizer, alcohol solution, or an alcohol wipe.

Depending on the type of wound, the procedure may vary slightly, but in general it is as follows:

Examine the wound, determine what its nature is and how severe the damage is

· Try to stop the bleeding.

Rinse the wound with hydrogen peroxide (3%), a solution of chlorhexidine or furacilin (0.5%), or a solution of pink potassium permanganate (it must be filtered through gauze). Dry the wound with a tissue.

· Treat the skin around the wound with an antiseptic and apply a sterile bandage. Afterwards, do not forget to do dressings.

Make a decision about the need to see a doctor. Take a pain reliever if necessary.

Almost all “household” wounds are dirty, so it is very important to clean the wound, if possible, without touching it with your hands. A clean wound will heal faster and help avoid complications.

Only the edges of the wound need to be treated. You can not pour alcohol, iodine, brilliant green, etc. into it, otherwise you will burn the tissues, and as a result, instead of a small scar, a huge scar may appear at the site of the wound.

If the wound is deep, stop the bleeding with a pressure bandage and seek immediate medical attention. Just remember that a pressure bandage should not be applied for more than half an hour.

On cuts and lacerations, you can apply an antibacterial and wound-healing ointment Levomekol, and a sterile bandage on top.