penetrating wound

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Related to penetrating wound: perforating wound


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.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

pen·e·trat·ing wound

a wound with disruption of the body surface that extends into underlying tissue or into a body cavity.
Farlex Partner Medical Dictionary © Farlex 2012

pen·e·trat·ing wound

(pen'ĕ-trāt'ing wūnd)
A wound with disruption of the body surface that extends into underlying tissue or into a body cavity.
Medical Dictionary for the Health Professions and Nursing © Farlex 2012
References in periodicals archive ?
The cervical penetrating wounds, to which our case is related, are an illustration.
Initial multi-slice computed tomography (MSCT) performed at another medical institution showed penetrating wound of the right orbital roof without affection of the right bulbus, and endocranial impressed bone fragments into the right frontal brain lobe with pneumocephalus and minimum hemorrhage (Figs.
Of the 896 recorded injuries, lacerations were encountered as external injury in 427(47.7%) cases, followed by penetrating wounds in 137(15.3%).
The man, aged 35, suffered a penetrating wound to the thigh and the lost a lot of blood.
The fatal blow was the deep and penetrating wound to the chest which almost immediately resulted in a young woman of 18 being dead and a baby of 68 days having no mother."
Yesterday, the jury was told pathologists who examined her body both agreed she died "with in a small number of minutes" of suffering the penetrating wound.
Mr McBroom was stabbed in the chest and Mr Reid also suffered a deep penetrating wound to his chest.
(6) A penetrating wound in proximity to vascular structures is considered an indication for angiography only in cases in which a bullet follows the course of a major artery over a long segment.
A post-mortem by a Home Office pathologist found Mitchel died from a penetrating wound to the head.
An unusual case of a penetrating wound of the orbit.
The Ministry of Interior stated that Dawoud sustained several wounds at his left chest, one penetrating wound, and cuts at his right arm.
Ms Flintham had suffered a penetrating wound to her left upper abdomen.