TYPES OF WOUNDS

Incisional wound: a wound caused by a cutting instrument, having neat edges.
 
Lacerated wound: a wound where the tissues are torn, usually by blunt force leaving ragged edges. 
 
Open wound:  a wound that communicates directly with the outside.
 
Penetrating wound:  a wound which passes through, the skin into the underlying tissues typically caused by a sharp thin object.
 
Perforating wound: a penetrating wound which extends into an organ or bodily cavity.
 
Surgical wound/incision: this wound is produced during a surgical procedure, usually having neat edges.
 

Abrasion: a type of wound in which the skin is scraped or rubbed off. 

Contusion: a closed wound where the skin is not broken but underlying tissues are damaged. When blood vessels are also broken it causes a bruise.

Pressure sores: A localised injury to the skin usually over a bony prominence typically resultant of pressure, shear or friction forces or combinations thereof

Ulcers

1. Venous ulcers: Poor veins lead to a condition known as venous insufficiency. Blood fails to return to the heart and pools in the legs (most noticeably about the ankles and calves). Increased venous pressure causes fibrin to be deposited around the capillaries this then in turn acts as a barrier to the flow of oxygen and nutrients to the tissues leading to cell death and ulceration.

  Characteristics of venous ulcers:

• Located below the knee, most often on the inner part of the ankles.
• Relatively painless unless infected.
• Associated with aching, swollen lower legs that feel more comfortable when elevated.
• Surrounded by brown and/or dry, itchy and reddened skin this is known as venous eczema.
• Often associated with swelling, thickened skin, scalieness, fissuring, oozing.

2. Arterial ulcers: Poor arterial circulation caused by damage to the arteries from atherosclerosis leading to occlusion of these arterial vessels. The arteries fail to deliver the oxygen and nutrients (typically noted at the extremities of limbs) leading to tissue death and necrosis with ulcer formation.

   Characteristics of arterial ulcers:

• Usually found on the feet, heels or toes, at the ends of the circulation. They are painful, especially if legs are at rest and elevated. Pain is relieved when the feet are lowered as gravity causes more blood to flow into the legs.
• The borders of the ulcer have a ‘punched out’ appearance
• Associated with cold white or bluish, shiny feet.
• There may be cramp-like pains in the legs when walking, known as intermittent claudication.
• Ankle Brachial Pressure Index (ABPI) by using a Doppler probe to measure pressure in the arm and the ankle can help indicate the arterial disese. The normal value 0.92 to 1.3. If the ABPI is less than 0.9, there is likely to be arterial disease. Levels of less than 0.5 indicate severe arterial disease.

3. Diabetic (neuropathic) ulcers:  Caused by the combination of arterial blockage and nerve damage they occur most commonly on the foot. The nerve damage of diabetes reduces awareness of pressure, heat or injury. These forces applied upon the foot go unnoticed and cause damage to the skin and subsequent ‘neuropathic’ ulceration.

  Characteristics of diabetic ulcers: 

• Diabetic ulcers have similar characteristics to arterial ulcers however are typically over pressure points such as heels, tips of toes and between toes. In response to pressure, the skin increases in thickness (callus) but with a minor injury breaks down and ulcerates.

Infected Wounds: Invasion of the wound by pathogenic microorganisms, producing tissue injury.

There are various levels of infection:

1. Contamination: Bacteria are on the wound surface there is no multiplication therefore No impairment to healing and No obvious signs of infection
2. Colonisation:  Bacteria are dividing however there is No impairment to healing and No obvious signs of infection
3. Topical infection:  Bacteria are dividing and have invaded the wound surface. A Biofilm may be present. Impairment to healing is occurring with subtle clinical signs of infection such as dull wound tissue; absence of bright granulation tissue and slough. Hypergranulation may be present with rolled or raised wound edges
4. Local infection:  Bacteria have invaded the local tissue with impairment to healing There is wound breakdown with increase in size, erythema and pain. It is usually associated with purulent or discoloured exudate. Often there is malodour and increased temperature at the wound site
5. Cellulitis:  Bacteria have invaded the surrounding tissue with associated advancing infective signs developing such as redness, swelling, heat and pain. Systemic signs of temperature and malaise are variable.
6. Sepsis:  Bacteria have entered the blood stream and are spreading to distant organs. This is a very concerning phase with the patient usually systemically unwell with possibility of pending circulatory collapse.

Chronic Wounds: Any wound that fails to heal in an orderly and timely manner. The clinical signs of chronic wounds include:

• Non-viable wound tissue with slough and or necrosis
• Lack of granulation tissue; appearing pale, greyish and avascular
• No reduction in wound size over time
• Recurrent wound breakdown