Open Wound Basics

In general, wounds can be either be classified as closed (where the skin stays intact) or open. In open wounds, the skin is cracked open, leaving the underlying tissue exposed to the outside environment, which makes it more vulnerable to bleeding and infections.

Causes, Types and Symptoms

• Abrasions: These are shallow irregular wounds of the upper layers of skin, due to skin brushing with either a rough surface or a smooth surface at high speed (running); usually present with minor to no bleeding, with some pain that subsides shortly after initial injury.

• Lacerations: These wounds are tear-like wounds with irregularly torn edges that are usually deeper than abrasions and cause more pain and bleeding. Lacerations are generally caused by trauma or contact with an object; such as hard blows, collusions or accidents.

• Incisions: These are most likely the result of a surgical procedure or skin cut with a sharp object; like scalpels, knives and scissors. Incisions are mostly linear in shape with sharp, smooth edges.

• Depending on the depth and site of the wound, an incision can be life threatening, causing serious damage; especially if it involves vital organs, major blood vessels or nerves.

• Punctures: These are small rounded wounds that result from objects with thin pointed tips; such as needles, nails or other tapered objects, and teeth, in cases of human or animal bites. The wound size, depth, bleeding and pain are directly related to the size and force of the causative object.

• Penetrating: This type of wound can be caused by any object or force that breaks through the skin to the underlying organs or tissue. It has variable sizes, shapes and presentations; depending on the cause. Penetrating wounds can be life threatening, causing serious injury; especially if involving vital organs, major blood vessels or nerves.

• Gunshot wounds: These are considered to be penetrating wounds that are exclusively caused by bullets from firearms (guns, rifles, etc.). These wounds at entrance are regular, rounded, and smaller than the bullet size. The entrance wounds may have burn marks or soot on the edges and surrounding tissue, depending on the distance from which the bullet was fired. If the bullet goes all the way through the body, the exit wound will have an irregular shape that is larger than the entrance wound and usually bleeds more. Bullets move in a straight line through the body, except when they hit a bone. If they hit a bone, they can either break or shatter it, or be deflected in another direction. Aside from the risk to vital organs or major blood vessels, the fast, spinning movement of the bullet may cause serious damage to the surrounding tissue it passes through.

Complications

Generally speaking, open wounds may have one or more of the following complications:

• Infections: Except for surgical incisions, most open wounds are caused by dirty, contaminated objects that carry different types of bacteria and organisms. An infected wound may present with a foul odor, pus or yellowish drainage, fever and pain.
• Inflammation: This can result from the body's immune response to a foreign material that caused a wound. Inflammation can make the wound area red, hot, swollen and painful.
• Loss of function: Whether because of the pain or the trauma itself, loss of function can be temporary or permanent, depending on the extent of the wound and the damage to the affected limb or area.
• Scarring: Many open wounds will leave a scar after healing, and some may even cause a deformity of the affected area; especially with penetrating, gunshot or deep laceration wounds.

Treatment Options

Open wounds are treated as follows:

• Stop the bleeding: Apply gentle pressure over the wound with a clean bandage for twenty to thirty minutes. Try to avoid checking frequently to see if the bleeding has stopped, as this may prevent the blood from clotting as needed.

• Clean the wound: Remove the causative object(s), wash the wound with clean water, and flush it with a sterile solution (with an irrigating syringe) to remove any bacteria or remaining debris. In some cases, a surgical debridement is necessary to remove the dead tissue and all of the foreign material that couldn’t be removed during initial cleaning. Removing the debris from clothes, dirt, glass, bullets, metals or other sources can reduce the risk of infection and provide a clean environment that promotes the healing process.

• Local antibiotic: Apply a thin layer of antibiotic ointment (such as Neosporin) on top of the wound to reduce the risk of infection.

• Wound closing: Wounds can be closed with stitches, staples, skin adhesive bands or sterile bandage wound dressings (for abrasions). Wound closing brings any separated tissue together and repairs any damaged organ(s) or tissue to promote the healing process. However, in cases of infected surgical wounds, the wound may be left open after surgery until the infection resolves. Closure of an infected wound can lead to more complications and failure to heal properly.

• Dressing change: Change the wound dressing at least once daily, particularly when it is wet from blood or drainage.

• Tetanus: If it has been more than five years since the last tetanus vaccination, a booster or new tetanus shot should be given. This is especially important in cases of deep, dirty, contaminated wounds, or in those caused by human or animal bites.

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