Wound Types

Acute Wounds
Acute wounds can occur from traumatic abrasions, lacerations, and superificial skin and soft tissue injuries.1 Acute wounds tend to heal spontaneously without complications through the four phases of wound healing which are hemostasis, inflammation, proliferation, and maturation.

Chronic Wounds
The problem of chronic wounds...
Chronic wounds are wounds that fail to heal within a six-to-twelve week period of best clinical practice.2 They are a challenge to both healthcare professionals and patients because they last a long time, causing a loss of body image and making the person more susceptible to infection. Several factors can impair the normal healing process such as infection, necrotic tissue, impaired tissue perfusion and steroids.3 Chronic wounds can occur anywhere on the body including the lower extremities. They are commonly referred to as diabetic foot ulcers, venous stasis ulcers and pressure ulcers. Chronic wounds fail to progress through an organized, orderly and timely sequence of wound repair. The patients involved may have other pre-existing medical conditions such as diabetes mellitus that could contribute to the non-healing, chronic wound. It is important to determine the underlying etiology of the chronic wound and identify the factors that interfere with the healing process such as malnutrition, poor glucose control, excessive pressure to an area, anemia and persistent edema. Elderly patients who are experiencing a chronic wound may have multiple medical conditions that necessitate a non-surgical approach to wound healing. Acceleration of wound closure is important for individuals with chronic wounds because they are at risk for infection, and these wounds can interfere with activities of daily living.

The common types of chronic wounds are as follows:

Diabetic Foot Ulcers (DFU)Diabetic foot ulcers are a significant problem on a global basis. Approximately 15% of people with diabetes will develop a foot ulcer and it is estimated that more than half of these will experience a second ulcer. Diabetic foot ulcers occur most commonly due to neuropathy (loss of sensation in the lower extremity) and peripheral vascular disease. Neuropathy can occur partially as a complication of prolonged glucose elevation.4 Failure of diabetic foot ulcers to heal may result in amputation. The main reasons for diabetic foot ulcers failing to heal are two-fold. The first is because the person with the foot ulcer continues to walk on the ulcer causing irritation and skin breakdown. They may also have some type of foreign body enter the skin and be unaware of this happening. For the healing process to take place, these wounds usually must have weight redistributed away from the wound in what is known as offloading. Specialty shoes and devices are available to assist with this process. The second main reason that these ulcers fail to heal is related to poor diabetes control. Uncontrolled blood sugar can prevent the body from healing itself by interfering with various healing processes. In addition to blood sugar control, management of diabetic wounds includes prevention of weight bearing (off loading), debridement of devitalized tissue, prevention of infection and local wound management.

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Venous UlcersVenous Ulcers are the most common and costly chronic wound ulcer seen in the United States and affect women three times more often than men. The prevalence of lower limb ulcers ranges from 0.12% to 0.32% of the general population.5 Patients experiencing venous ulcers suffer from the inability to heal and the high rate of reoccurrence at 72%.5 Venous ulcers can cause

pain, limit activities of daily living and negatively impact quality of life.

Venous ulcers can be caused by damaged or leaky venous valves, or a faulty calf muscle pump action which causes sustained high venous pressure known as venous hypertension. These ulcers are usually located around the medial malleolus and are accompanied by edema or swelling of the affected leg, large amounts of drainage, and often have a scaly type of skin condition known as dermatosis. It is important to note that not all leg ulcers are venous in origin particularly those ulcers located above or below the gaiter and ankle region. People with venous insufficiency sometimes report having had a blood clot in the affected limb. Due to the interruption of blood flow back to the heart, pooling of blood is seen in the limb that sometimes results in swelling. Eventually, protein from blood vessels can leak into the tissue and cause an ulcer to form. A cornerstone of treatment for venous ulcers beyond local ulcer management is the use of sustained compression in order to decrease the edema by wrapping the legs to promote blood flow back to the heart. Pressure UlcersPressure ulcers are also known as decubitus ulcers or bed sores and have a psychologic, physiologic and economic impact on the individual. Pressure ulcers can result from immobility and can occur in persons that are bed ridden, who have had a spinal cord injury, or are in a wheelchair. Prevalence and incidence across all care settings varies, ranging from 0.4% to 38% in general acute care, 2.2% to 23.9% in long-term care, and 0% to 17% in home care.6 The tissue injury that occurs sometimes is a result of sustained pressure to a bony prominence area such as the hip or heel. The sustained pressure prevents adequate blood flow and causes the tissue to die. The wounds often fail to heal for a variety of reasons. One main reason is that pressure is not relieved from the wound. Special mattresses, bed and seating cushions are designed to help to relieve pressure to allow better blood flow to the injured area. Other reasons for these wounds to fail to heal often have to do with other underlying medical conditions that affect individuals, such as poor nutrition and incontinence, shear and friction. Pressure ulcer management includes pressure relief/pressure reduction, proper positioning, prevention of infection and local wound management.

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Types of wounds

Wound, sewn with four stitches

A laceration to the leg

An abrasion Open Open wounds can be classified according to the object that caused the wound. The types of open wound are: Incisions or incised wounds, caused by a clean, sharp edged object such as a !nife, a ra"or or a glass splinter. #ncisions which in$ol$e only the epider%is are legally classified as cuts, rather than wounds. Lacerations, irregular wounds caused by a blunt i%pact to soft tissue that lies o$er hard tissue &e.g. laceration of the s!in co$ering the s!ull' or tearing of s!in and other tissues such as caused by childbirth. (acerations %ay show bridging, as connecti$e tissue or blood $essels are flattened against the underlying hard surface. The ter% laceration is co%%only %isused in reference to injury with sharp objects, which would not display bridging &connecti$e tissue and blood $essels are se$ered'. Abrasions &gra"es', superficial wounds in which the top%ost layer of the s!in &the epider%is' is scraped off. Abrasions are often caused by a sliding fall onto a rough surface. Puncture wounds, caused by an object puncturing the s!in, such as a nail or needle. Penetration wounds, caused by an object such as a !nife entering the body Gunshot wounds, caused by a bullet or si%ilar projectile dri$ing into or through the body. There %ay be two wounds, one at the site of entry and one at the site of e)it, such is generally !nown as a through and through. #n a %edical conte)t, stab wounds and gunshot wounds are considered %ajor wounds. Closed *losed wounds ha$e fewer categories, but are just as dangerous as open wounds. The types of closed wounds are: Contusions, %ore co%%only !nown as bruises, caused by blunt force trau%a that da%ages tissue under the s!in. Hematomas, also called blood tu%ors, caused by da%age to a blood $essel that in turn causes blood to collect under the s!in. Crushing injuries, caused by a great or e)tre%e a%ount of force applied o$er a long period of ti%e.

Healing To heal a wound, the body underta!es a series of actions collecti$ely !nown as the wound healing process. Infection +acterial infection of wound can i%pede the healing process and lead to life threatening co%plications. ,cientists at ,heffield -ni$ersity ha$e identified a way of using light to rapidly detect the presence of bacteria. They are de$eloping a portable !it in which specially designed %olecules e%it a light signal when bound to bacteria. *urrent laboratory based detection of bacteria can ta!e hours or e$en days..1/ Cultural history 0ro% the *lassical 1eriod to the 2edie$al 1eriod, the body and the soul were belie$ed to be inti%ately connected, based on se$eral theories put forth by the philosopher 1lato. Wounds on the body were belie$ed to correlate with wounds to the soul and $ice $ersa3 wounds were seen as an outward sign of an inward illness. Thus, a %an who was wounded physically in a serious way was said to be hindered not only physically but spiritually as well. #f the soul was wounded, that wound %ay also e$entually beco%e physically %anifest, re$ealing the true state of the soul..2/ Wounds were also seen as writing on the 4tablet4 of the body. Wounds gotten in war, for e)a%ple, told the story of a soldier in a for% which all could see and understand, and the wounds of a %artyr told the story of their faith..2/