Wound and its Classification

Wound: A wound is a break in continuity of soft tissue caused by injury, trauma, surgery, cut, blow,
chemicals, heat, cold, pressure etc.

Wound Healing: Process

Bleeding Haemostasis

dominant cell: platelet

Inflammation

dominant cell: neutrophil macrophage

Proliferation

dominant cell: macrophage fibroblast

Maturation Contraction

dominant cell: fibroblast myofibroblast

Epithelialisation
dominant cell: epithelial cell

Classification of Wounds on different basis:

1) Based on loss of tissue:

S.N Types Loss of

1 Superficial Epidermis only
2 Partial thickness Epidermis+dermis
3 Full thickness Dermis+S/C fat+bone(sometimes)

2) Based on whether skin is broken or not: Open Wounds and Closed Wounds

Open Wounds: Break in continuity of the skin

S.N Types Comments

1 Incised
2 Lacerated
3 Punctured
4 Penetrating
5 Perforating
6 Gunshot
7 Abrasions
8 Avulsions
By clean sharp-edged objects as knife, razor etc
irregular tear-like wounds caused by some blunt trauma
caused by a sharp pointed object puncturing the skin like nails,
needles
Deep wound communicating with cavities like abdomen, thorax, joints etc
Wound with two openings; one entrance and the other exit
By fire arms (bullet or similar projectiles)
Only topmost layer of skin (epidermis) is removed
A body structure is forcibly detached from its normal point of insertion
Closed Wounds: No break in continuity of skin but underlying tissues are damaged

S.N Types Comments

1 Contusion By blunt oblects without breaking skin continuity
2 Bruise Mild degree contusion
3 Haemotoma Caused by injury to superficial vein

3) Surgical wound classification

S.N Types Comments

1 Clean Uninfected. No break in asepsis, no hollow organ entered
2 Clean Contaminated Hollow muscular organ is open red but no spillage
3 Contaminated Pus encountered, major break in asepsis
4 Dirty Hollow muscular organ is open red with gross spoilage

4) Based on healing time

S.N Types Comments

1 Acute heal uneventfully (with no complications) in the predicted amount
of time
2 Chronic take a longer time to heal and might have some complications

Characteristics of different wounds

Incised Wounds

Broader than the edges of weapon causing it due to retracton

Spindle shaped and gaping
Superficial extent greater than depth
Gaping is greater in deep wound when muscle fibre is cut
Edges are smooth and clean cut and everted
Inverted if muscle fibres are united to the slin, eg. scrotum
Edges irregular if skin loose or cutting edge of the weapons blunt
Heavy cutting weapons eg. axe, shovel-edge may be smooth
Curved weapons eg. sickle first produce a stab or punctured wounds than an incised wound
Direction of wound is important
Haemorrhage is much more than in any other wounds. If the main artery is cut death may occur

Punctured Wounds

Sharp pointed cutting instruments: clean cut edges and have sharp angles at the two extremities
if they have two cutting edges
One cutting and one blunt edge instruments: Bruising and ragged to one end, wedge shaped
wound
Sharp pointed and cylindrical/conical wounds. Wounds have circular or slit like openings. Blunt
pointed causes punctured wound with laceration
 Aperture of punctured wounds: Smaller than the breadth of weapons. Death is much larger than
ts length/width. There is little external haemorrhage

Lacerated Wounds

Skin around the seat of injury is ecchymosed

Foreign bodies eg mug, grease, hair, machine oil
When produced by blunt weapons eg. Clubs, spare bricks etc is accompanied by considerable
amount of bruising
When heavy weight reg. vehicle wheel, truck pass over it tears the skin and crushes the muscle
Haemorrhage is not as extensive as the artery are not cut but torn

Firearm Wounds

Nature of Projectiles
Larger bullet causes greater damage to internal tissue
Conical bullet produces much less laceration than round one and produces punctured wound in
appearance.
Round bullet split the tissue conical rarely does it
Steel jacket bullet passes straight and directly through the body without any deviation

Velocity of Projectile
High velocity bullet produces clean circular, punctured out aperture/split and perforate the
body without any deviation
Low velocity bullet causes contusion or laceration of the margin of the wound
Easily deflected by striking hard objects and often lodges in the body
Takes widen as it goes deeper (reverse of punctured wounds)

Distance of the Projectile

If close to the body/ in actual contact, wound of entrance are lacerated
Surrounding skin scorched and smoke backed by smoke
Tattooed with unborn gunpowder
If gunpowder is smokeless no blackening of the skin
Grayish/white deposit on the skin around the wounds
If the distance is more than 4 feet no blackening and scorching

Refrences:
Veterinary Surgical Techniques by Amresh Kumar
Essentials of Veterinary Surgery by A. Venugopalan
Draft notes on Ethics and Jurisprudence by Dr. Shyam Bdr. Raut
https://en.wikipedia.org/wiki/Wound