Closed Wound Basics

In general, wounds can be either open or closed. In open wounds, the skin is broken and the underlying tissue is exposed to the outside environment. In closed wounds, the skin is intact and the underlying tissue is not directly exposed to the outside world.

Causes and Symptoms of Closed Wounds

Closed wounds are usually caused by direct blunt trauma sustained when falling down or in motor vehicle accidents. Even with the skin intact, the damage can reach down to the underlying muscle, internal organs and bones. Crush wounds can sometimes be caused by heavy falling objects, such as might happen in a car accident or collapsing building.

Types of Closed Wounds

Major types of closed wounds are:

  • Contusions: These are a common type of sports injury, where a direct blunt trauma can damage the small blood vessels and capillaries, muscles and underlying tissue, as well the internal organs and, in some cases, bone. Contusions present as a painful bruise with reddish to bluish discoloration that spreads over the injured area of skin.
  • Hematomas: These include any injury that damages the small blood vessels and capillaries resulting in blood collecting and pooling in a limited space. Hematomas typically present as a painful, spongey rubbery lump-like lesion. Hematomas can be small or large, deep inside the body or just under the skin; depending on the severity and site of the trauma.
  • Crush injuries: These are usually caused by an external high pressure force that squeezes part of the body between two surfaces. The degree of injury and pain can range from a minor bruise to a complete destruction of the crushed area of the body, depending on the site, size, duration and power of the trauma.

Complications of Closed Wounds

Closed wounds can be complicated by severe bleeding, large bruises, nerve damage, bone fractures and internal organ damage. However, the most serious complication of closed wounds is known as the compartment syndrome. This syndrome involves the lower and/or upper limbs (especially the legs and forearms), where the damage causes swelling and increased pressure in the fascia that surrounds the muscles, nerves and blood vessels in that area. The increased pressure can block the blood supply to the affected limbs, causing severe damage to the muscles and nerves. The damage can be permanent, leading to loss of function, and may necessitate amputation.

Closed Wound Treatments

In closed wounds, the main goal of treatment is to control the pain, and keep the bleeding and inflammation to a minimum. This is done by using ice packs, compression, elevation and immobilization of the affected limb or area. However, in cases of compartment syndrome, a physician can make linear surgical cuts through the fascia to alleviate the pressure. The wound is usually left open for two to three days while covered with a sterile bandage to allow the swelling to subside and prevent further pressure from building up.

X-ray can be used if bone fracture is suspected. Fractures generally require casting. In cases of severe trauma, other forms of imaging may be used. These include ultrasound, CT scan and MRI, which can detect organ damage and internal bleeding. Topical antibiotic ointment may be applied locally to wounds in cases of associated skin lacerations and abrasions.

The use of crutches and other walking aids may be prescribed to immobilize the injured limb or area. These can be especially helpful for injuries to weight bearing sites, to prevent further damage, reduce pain and accelerate healing. A tetanus shot, painkillers and anti-inflammatory medications can also be helpful.

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