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  Skin & Hair

February 2012
Skin Wounds
Dr Sachin Varma
 
A wound is an injury to the skin. The skin may be torn, cut, punctured or bruised. In pathology it refers to any injury that damages the dermis of the skin. It is a common injury and nearly everyone has experienced one type of wound or another. Minor wounds are especially common in childhood.


Types of Wounds

Based on duration

  • Acute Wound: Acute is a new wound resulting from an acute injury or trauma.
  • Chronic wound: It is typically a long standing wound which takes a long time to heal, usually existing for six weeks or more.

Based on appearance

  • Open Wounds
  • Closed Wound

Open Wounds
These are wounds that present as raw open areas and are of various types:

  • Cut wounds or incision wounds are a result of cuts by a clean, sharpedged object such as a knife or a glass cutting into the skin.
  • Lacerations are irregular tear-like wounds caused by blunt trauma.
  • Abrasions are superficial wounds in which the topmost layer of the skin is scraped off. Theyare often caused by sliding or falling on a rough surface.
  • Puncture wounds are caused by an object puncturing the skin, such as a nail or needle. t Penetration wounds are caused by an object, such as a knife, entering and coming out from the skin.
  • Missile wounds, also called velocity wounds, are caused by an object entering the body at a high speed, typically a bullet.
  • Avulsions occur when an entire structure or part of it is forcibly pulled away; such as the loss of a permanent tooth or an ear lobe.

From a purely clinical point of view, abortion is a safe procedure when performed under the supervision of a qualified medical professional and under appropriate sanitary conditions. There is no scientific evidence to show that a woman going in for an abortion risks infertility. An improperly done abortion can however lead to infection and result in sub-fertility.

Causes of infection
  • Incomplete evacuation of the uterus during abortion leads to infection. It may be contracted through the vagina, blood or surgical intervention.
  • Products retained inside the uterus during the procedure can result in pelvic inflammatory disease (PID).
Closed Wounds
Closed wounds are wounds beneath the skin where the skin surface remains intact despite the injury. They are of few types but are just as dangerous as open wounds. The types of closed wounds are:
  • Contusions, more commonly known as bruises, are caused by blunt force trauma that damages tissues under the skin.
  • Hematoma, also called a blood tumour, is caused by damage to a blood vessel that causes blood to collect under the skin. t Crush injury or crush wounds occur when a heavy object falls on a person, splitting the skin and shattering or tearing underlying structures.

Signs and symptoms
Clinical presentation of wound may vary. It can present from an actively bleeding wound, to simple abrasion with no active bleed, to redness and swelling. Pain and tenderness of the injured area may be a common factor in most wounds. Some wounds will present late with signs of complications like secondary infection and pus discharge.

Diagnosis
A diagnosis is usually done by visual examination of the wound by the doctor and taking a history of the causal events. The doctor will have to assess the nature of the wound, its severity, extent of underlying damage and general health of the patient, before making a final judgement about the wound. Wound culture, X-rays or ultrasound may be three of the investigations recommended by a doctor, based on the extent and nature of the wound .

Treatment
Many times wounds can be treated at home. Treatment of wounds involves four important measures:
  • Stopping active bleeding: This is done by applying mild pressure over the wound surface with a clean cloth for 5-10 minutes. Usually it stops bleeding in most cases. Medical help should be immediately sought if bleeding does not stop.
  • Cleaning and removing any foreign body: Cleaning should be done by using tap water or sterile saline or antiseptic solution.
  • Dressing: Open wound should always be dressed after applying an antibiotic cream and then covering it with a sterile cotton dressing. Dressing prevents secondary infections
  • Additional medical attention may be required based on the severity of wound, for example, deep incisional wounds may require surgical closure and severe internal injuries may require urgent medical help.
Most minor wounds are preventable by following basic safety rules. Children especially, should be informed of day-to-day safety norms. But, in case someone does get wounded, any condition where you think medical help may help heal the injury faster.

When to call the Doctor
Wound management at home suffices in most cases. However, a patient should be aware as to when medical aid becomes necessary:
  • Impaction of a foreign body in the wound, especially in nose or eye or ear.
  • Larger penetrating objects (fish hook, arrow, etc) stuck in the wound. It should only be removed by a doctor to prevent further damage.
  • Actively bleeding wounds. t Large lacerations that can’t be approximated as it will require suturing and closure.
  • Deep wounds to assess the damage to deeper structures, especially to nerve and tendons.
  • Chemical or acid burns. Puncture wounds or wounds by rusted metals or dirt embedded in wounds for a tetanus shot.
  • Animal bites for rabies vaccination.

Dr Sachin Varma Consultant Dermatologist Apollo Gleneagles Hospital Kolkata


    
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