wound

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wound

 [wo̳nd]
an injury or damage, usually restricted to those caused by physical means with disruption of normal continuity of structures. Called also injury and trauma.
blowing wound open pneumothorax.
contused wound one in which the skin is unbroken.
wound drain any device by which a channel or open area may be established for the exit of material from a wound or cavity. See also wound healing.
wound healing restoration of integrity to injured tissues by replacement of dead tissue with viable tissue; this starts immediately after an injury, may continue for months or years, and is essentially the same for all types of wounds. Variations are the result of differences in location, severity of the wound, extent of injury to the tissues, the age, nutritional status, and general state of health of the patient, and available body reserves and resources for tissue regeneration.



The repair of damaged cells and tissue takes place by regeneration, in which structures are replaced by proliferation of similar cells, such as happens with skin and bone; and by formation of a scar, consisting of fibrous structures with some degree of contraction. Since most wounds extend to more than one type of tissue, complete regeneration is impossible; therefore, scar formation is an expected outcome of wound healing.

In healing by first intention (primary union), restoration of tissue continuity occurs directly, without granulation; in healing by second intention (secondary union), wound repair following tissue loss (as in ulceration) is accomplished by closure of the wound with granulation tissue. This tissue is formed by proliferation of fibroblasts and extensive capillary budding at the outer edges and base of the wound cavity, with slow extension from the base and sides of the wound toward its center. If, however, the wound is very deep and extensive, granulation tissue cannot fill the defect and grafting may be needed to cover the space and avoid severe contracture and loss of function. healing by third intention (delayed primary closure) occurs when a wound is initially too contaminated to close and is closed surgically 4 or 5 days after the injury. (See also illustrations at healing.)

The insertion of drains can facilitate healing by providing an outlet for removing accumulations of serosanguineous fluid and purulent material, and obliterating dead space such as that created by surgical removal of an organ.

If the area of injury is not very large, the products of inflammation, small blood clots, and other debris from the wound can be absorbed into the blood stream and disposed of. Wounds that are filled with large amounts of dead cells, blood clots, and other debris must be cleansed in order for healing to take place. This can be accomplished by surgical or chemical débridement or by irrigations. Enzymes are sometimes used to remove the debris by enzymatic action. Since foreign bodies, such as sutures, slivers of glass, splinters, and the like, can delay healing, they too must be removed from the wound to facilitate healing.
Patient Care. Assessment of the progress of wound healing begins with frequent inspection of the site for signs of bleeding in or around the wound. Discoloration of the skin adjacent to a surgical or traumatic wound that has been sutured may indicate a pooling of blood in the tissue spaces and the beginning stages of a hematoma. Bleeding in a wound and clot formation can delay healing. Accumulations of serosanguineous fluid and purulent drainage also must be watched for, because they retard the healing process and pose a problem of superinfection. If a drain has been inserted to remove excess fluid, the color, amount, odor, and other characteristics of the drainage must be noted and recorded. If there is more than one drain, the drainage from each should be noted separately.



Dressings also must be observed frequently, especially a pressure dressing, which can become dangerously restrictive if there is swelling. Any change in sensation, such as tingling or numbness, signs of impaired circulation, or complaint of discomfort, should be reported to the physician.

Other data important to the ongoing assessment of wound healing are the leukocyte count, coagulation tests, and electrolyte levels. An elevated body temperature can signal local or systemic infection. Another sign of infection is the presence of purulent drainage. The color of the drainage is often indicative of the particular infecting organism. For example, a yellow color may indicate presence of Staphylococcus aureus, and a blue-green color may indicate Pseudomonas aeruginosa infection.

In a surgical wound, a discharge of serosanguineous fluid on the fourth or fifth postoperative day may signal wound dehiscence and, therefore, should be reported immediately to the surgeon.

During the scarring phase of healing, the wound is inspected for changes in size, color, and shape, which can continue for months even in superficial wounds. New scar tissue is usually purplish, raised, and irregular. With time, the color fades, the scar grows smaller, and its surface and edges become less irregular. Sometimes the scar tissue grows to excess and extends beyond the normal limits of the wound. This hypertrophic scar or keloid may require steroid injections or surgical removal.

In order to achieve adequate and uneventful healing of a wound the patient must be in a good state of nutrition. Virtually every nutrient plays some role in the healing process; hence, a wide range of dietary nutrients must be supplied, either through oral feedings, supplemental vitamins and protein, or parenteral nutrition. Oxygen is also essential to the healing process. This means that measures must be taken to ensure adequate circulation of blood to the wound, employing measures such as exercise, ambulation when possible, and applications of warmth when prescribed. Positioning also is important to avoid prolonged pressure against blood vessels serving the wounded area. Adequate rest is needed to facilitate healing. The patient should understand the need for rest and the purpose of splints, casts, and other devices employed for immobilization of a wounded part.

Mechanical injury to a wound can greatly impede healing by damaging the tissues involved in the healing process. The wound should be protected from friction and direct blows. The affected part must be handled gently, and great care must be used in applying and removing dressings and bandages. Protective bandages and shields made from rubber, plastic cups, tongue blades, and other supportive materials may be needed to protect the wound from additional trauma.

Other factors that work against optimal healing are stress, old age, smoking, obesity, and diabetes mellitus. It is thought that in the poorly controlled diabetic patient there is an increased affinity of hemoglobin for oxygen, which hampers the release of oxygen to the healing tissues. Additionally, poorly controlled diabetic patients have an abnormal function of the phagocytes, which predisposes wounds to infection. Although cancer does not itself interfere with the healing process or make the patient more susceptible to infection, radiation therapy, steroids, and antineoplastic agents, as well as the general debility of the patient, do compromise healing in cancer patients.
Wound dressing construction and design. From Cohen et al., 1992.
incised wound one caused by a cutting instrument.
lacerated wound one in which the tissues are torn.
open wound one that communicates directly with the atmosphere.
penetrating wound one caused by a sharp, usually slender, object that passes through the skin into the underlying tissues.
perforating wound a penetrating wound that extends into a viscus or bodily cavity.
puncture wound penetrating wound.
sucking wound a penetrating wound of the chest through which air is drawn in and out, as in open pneumothorax.
tangential wound an oblique glancing wound that results in one edge being undercut.

wound

(wūnd),
1. Trauma to any of the tissues of the body, especially that caused by physical means and with interruption of continuity.
2. A surgical incision.
3. To inflict with a wound.
[O.E. wund]

wound

(wldbomacnd) trauma; an injury, usually restricted to a physical one with disruption of normal continuity of structures.
contused wound  one in which the skin is unbroken.
incised wound  one caused by a cutting instrument.
lacerated wound  one in which the tissues are torn.
open wound  one having a free outward opening.
penetrating wound  one caused by a sharp, usually slender object, which passes through the skin into the underlying tissues.
perforating wound  a penetrating wound that extends into a viscus or body cavity.
puncture wound  penetrating w.

wound

(wo͞ond)
n.
1. An injury to an organism, especially one in which the skin or another external surface is torn, pierced, cut, or otherwise broken.
2. An injury to the feelings.
v. wounded, wounding, wounds
v.tr.
To inflict wounds or a wound on.
v.intr.
To inflict wounds or a wound: harsh criticism that wounds.

wound′ed·ly adv.
wound′ing·ly adv.

wound

[wo̅o̅nd]
Etymology: AS, wund
1 any physical injury involving a break in the skin, usually caused by an act or accident rather than by a disease, such as a chest wound, gunshot wound, or puncture wound.
2 to cause an injury, especially one that breaks the skin.

Wound, Ostomy and Continence Nurses (WOCN) Society

an organization of nurses who manage conditions such as stomas, draining wounds, fistulas, vascular ulcers, pressure ulcers, neuropathic wounds, urinary incontinence, fecal incontinence, and functional disorders of the bowel and bladder. See also enterostomal therapist.

wound

Medtalk An injury caused by physical means. See Clean wound, Defense wound, Dirty wound, Entrance wound, Execution wound, Exit wound, Hesitation wound, Problem wound.

wound

(wūnd)
1. Trauma to any of the tissues of the body, especially that caused by physical means and with interruption of continuity.
2. A surgical incision.
[O.E. wund]

wound

(woond)
A break in the continuity of body structures caused by violence, trauma, or surgery to tissues. In treating the nonsurgically created wound, tetanus prophylaxis must be considered. If not previously immunized, the patient should be given tetanus immune globulin.

Patient care

Successful wound assessment relies on a thorough, organized approach. This assessment includes the wound's location, size, depth, undermining, drainage, wound edges, base, and surrounding tissues. Include an assessment for any redness, swelling, tenderness, and gangrene/necrosis. The assessment includes the patient's vital signs and measures used, which improve the wound healing. The assessment includes the patient's vital signs and measures taken to improve the wound healing. Multiple diagnostic modalities (such as radiographic studies) may be employed to further delineate the extent of the injury.

abdominal wound

A traumatic injury or surgical incision which may be superficial or extend to intraperitoneal or extraperitoneal organs or tissues. In cases of abdominal trauma, a careful examination (often including peritoneal lavage, ultrasonography, or computed tomographic scanning of the abdomen) is necessary to determine the precise nature of the injury and the proper course of treatment. Superficial injuries may require no more than ordinary local care; immediate laparotomy may be needed, however, when major bleeding or organ damage has occurred. Intravenous fluids, blood components, antibiotics, and tetanus prophylaxis are given when necessary. Major abdominal trauma may be overlooked in comatose or otherwise critically injured patients when there is no obvious abdominal injury. See: abdomen

bullet wound

A penetrating wound caused by a missile discharged from a firearm. The extent of injury depends on the wound site and the speed and character of the bullet. gunshot wound

Treatment

Tetanus booster injection or tetanus immune globulin and antibiotics, if indicated, should be given. An appropriate bandage should be applied. Emergency surgery may be necessary. Complications, including hemorrhage and shock, should be treated.

contused wound

A bruise in which the skin is not broken. It may be caused by a blunt instrument. Injury of the tissues under the skin, leaving the skin unbroken, traumatizes the soft tissue. Ruptured blood vessels underneath the skin cause discoloration. If extravasated blood becomes encapsulated, it is termed hematoma; if it is diffuse, ecchymosis. See: ecchymosis; hematoma

Treatment

Cold compresses, pressure, and rest, along with elevation of the injured area, will help prevent or reduce swelling. When the acute stage is over (within 24 to 48 hr), continued rest, heat, and elevation are prescribed. Aseptic drainage may be indicated.

crushing wound

, crush woundCrush injury.

fishhook wound

An injury caused by a fishhook becoming embedded in soft tissue. Deeply embedded fishhooks are difficult to remove. One should push the hook through, then cut off the barb with an instrument, and pull the remainder of the fishhook out by the route of entry. Antitetanus treatment should be given as indicated. Because these injuries often become infected, prophylactic use of a broad-spectrum antibiotic is indicated.

gunshot wound

Abbreviation: GSW
A penetrating injury from a bullet shot from a gun. At very close range, the wound may have gunpowder deposits and the skin burn marks. GSWs can crush, penetrate, stretch, cavitate, or fracture body structures. The severity of the wound may depend on the structures damaged, the velocity and caliber of the bullet, and the underlying health of the victim. See: bullet wound

knuckle wound

Any injury to the metacarpal bones, esp. one that results from a fist fight. These wounds commonly include fractures and penetrating injuries contaminated with oral or periodontal bacteria.
Synonym: knuckle tooth wound

knuckle tooth wound

Knuckle wound.

lacerated wound

Laceration.

nonpenetrating wound

Blunt trauma.
Enlarge picture
OPEN WOUND: An open cavitary wound

open wound

A contusion in which the skin is also broken, such as a gunshot, incised, or lacerated wound.
See: illustration

penetrating wound

A wound in which the skin is broken and the agent causing the wound enters subcutaneous tissue or a deeply lying structure or cavity.

perforating wound

Any wound that has breached the body wall or internal organs. The perforation may be partial or complete.

puncture wound

A wound made by a sharp-pointed instrument such as a dagger, ice pick, or needle. A puncture wound usually is collapsed, which provides ideal conditions for infection. The placement of a drain, antitetanus therapy or prophylaxis, and gas gangrene prophylaxis may be required. This will depend on the nature of the instrument that caused the injury.

subcutaneous wound

A wound, such as contusion, that is unaccompanied by a break in the skin.

sucking chest wound

A wound that penetrates the thorax and draws air into the pleural cavity, usually resulting in an expanding pneumothorax.

tunnel wound

A wound having a small entrance and exit of uniform diameter.

wound

Any injury involving a break in the surface of the skin or an organ by any means including surgical incision.

Wound

Any injury that breaks the skin, including cuts, scratches, and puncture wounds.
Mentioned in: Tetanus

wound

loss of tissue continuity, due to trauma/surgical incision

wound

(wūnd)
1. Trauma to any body tissues, especially caused by physical means and with interruption of continuity.
2. A surgical incision.
3. To inflict with a wound.
[O.E. wund]

wound,

n an injury to the body of a person, especially one caused by violence.
wound, incised,
n in medical jurisprudence, a cut or incision on a human body; a wound made by a cutting instrument.
wound repair,
n restoration of the normal structure after an injury.

wound

a bodily injury caused by physical means, with disruption of the normal continuity of structures.

avulsive wound
blowing wound
open pneumothorax.
wound contracture
contused wound
one in which the skin is unbroken.
wound débridement
wound dehiscence
wound drain
any device by which a channel or open area may be established for the exit of material from a wound or cavity. See also drain, drainage, wound healing (below).
wound healing
the restoration of integrity to injured tissues by replacement of dead tissue with viable tissue. The process starts immediately after an injury and may continue for months or years, and is essentially the same for all types of wounds. Variations in wound healing are the result of differences in location, severity of the wound, and the extent of injury to the tissues. Other factors affecting wound healing are the age, nutritional status and general state of health of the animal and its body reserves and resources for the regeneration of tissue.
In healing by first intention (primary union), restoration of tissue continuity occurs directly, without granulation; in healing by second intention (secondary union), wound repair following tissue loss (as in ulceration or an open wound), is accomplished by closure of the wound with granulation tissue. This tissue is formed by proliferation of fibroblasts and extensive capillary budding at the outer edges and base of the wound cavity. Healing by third intention (delayed primary closure) occurs when a wound is initially too contaminated to close and is closed surgically 4 or 5 days after the injury.
The insertion of drains can facilitate healing by providing an outlet for removing accumulations of serosanguineous fluid and purulent material, and obliterating dead space.
wound healing agents
topical agents which stimulate healing; includes preparations containing zinc, trypsin, neomycin, dyes and iodine.
incised wound
one caused by a cutting instrument.
lacerated wound
one in which the tissues are torn.
wound nonhealing
failure to heal despite appropriate treatment being given.
open wound
one that communicates directly with the atmosphere.
penetrating wound
one caused by a sharp, usually slender object, which passes through the skin into the underlying tissues.
perforating wound
a penetrating wound which extends into a viscus or bodily cavity.
pocket wound
chronic, nonhealing wound in which there is granulation tissue but the overlying skin does not adhere. Seen most commonly in the axillae or groin of cats.
puncture wound
penetrating wound.
sucking wound
a penetrating wound of the chest through which air is drawn in and out.
surgical wound
one deliberately produced during a surgical procedure, e.g. the original incision.
tangential wound
an oblique, glancing wound which results in one edge being undercut.
traumatopneic wound
sucking wound.