open 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.

o·pen wound

a wound in which the tissues are exposed to the air.

open wound

Etymology: AS, open + wund
a wound that disrupts the integrity of the skin.

o·pen wound

(ō'pĕn wūnd)
A wound in which the tissues are exposed to the air.
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
See also: wound

open

1. said of tissues, cavities and lesions which are normally enclosed when they are exposed to the environment.
2. not pregnant but capable of being pregnant.

open case
lesions which carry a heavy load of infection are exposed to the air and represent a potent source of infection for other animals, e.g. an open case of bovine tuberculosis where the cow has extensive pulmonary lesions which are open to the bronchi.
open-chest
usually refers to thoracotomy or other procedure in which there is an opening in the chest wall.
open-heart
surgery in which the heart itself is exposed.
open heels
when the heels in the horse's feet are wide apart.
open joint
the joint capsule and synovial membrane have been punctured and the synovial lining of the joint is exposed to the air.
open pen feedlot
the animals in the lot are without shelter.
open wound
one without apposition of skin edges or left without sutures, usually to allow drainage and healing by granulation.

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.
References in periodicals archive ?
An HIV positive patient suffering from an open wound, is potentially hazardous because of the high risk of transmission of the virus (blood-borne exposure), being a risk to the hotel staff and its residents.
This has been an open wound in Sweden for more than 50 years," Thoresson told AFP.
The pathogen primarily infects people who consume contaminated seafood, especially raw oysters, or those with open wounds that get exposed to contaminated sea water.
in his abdomen, leaving a large open wound, according to prosecution records.
Emmanuel David, aged 11, lives in Soroti, Uganda, and has lived most of his life with an open wound on his head after being badly burnt when he was just three months old.
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NNA - 15/2/2012 - Sport and Youths Minister Feisal Karami called on the legitimate security forces to end the strife in the city of Tripoli and close the open wound.
The swelling has pretty much gone down, but there is still an open wound and it's heavily bandaged.
He has little choice but to open his doors to a film crew 24/7 and hopes living his life like an open wound will get him back on top.
When she returned home she had a huge open wound on her back.
His tail has not been docked properly and the large open wound on his neck was a deliberate act of cruelty.
He also suffered an open wound on the inside of his left ankle.