Wounds

Wounds are injuries that disturb the continuity of the skin and underlying tissues. They range from minor abrasions to deep penetrating injuries and can affect soft tissue, muscle, bone, or vessels. Wounds may be acute, healing within days to weeks, or chronic, failing to progress through standard healing. Healing is influenced by tissue perfusion, infection, mechanical factors, and systemic conditions such as diabetes or malnutrition.

Wound depth is typically described as superficial (epidermis only), partial thickness (dermis involved), or full thickness (subcutaneous tissue and possibly deeper structures). Wounds are also categorized by mechanism—abrasion, laceration, incision, puncture, or avulsion—and by contamination level, from clean to dirty or contaminated.

Healing occurs in four overlapping stages: hemostasis, inflammation, proliferation, and maturation. Primary healing occurs when wound edges are closely approximated; secondary healing occurs when edges cannot be brought together and tissue fills from the bottom up. Delayed closure, or tertiary intention, is used when closure is postponed after initial management.

Initial care includes controlling bleeding, cleaning with clean water, removing debris if safe, and applying a sterile dressing. Seek medical care for deep, heavily bleeding, contaminated, or joint- or bone-containing wounds, or when tetanus vaccination is incomplete. Signs of infection include increasing redness, swelling, warmth, pus, or fever.

Chronic wounds, such as pressure ulcers, venous leg ulcers, and diabetic foot ulcers, require ongoing management of underlying factors, dressing choices, and sometimes debridement or specialist care. Preventive measures include prompt wound cleaning, keeping wounds moist but not drowned, and protecting wounds from further injury.