Wound vs cut? Different types of wound? Management of wound 2+ 6+6
Reading File
Finding Sources
Finding Sources
Finding Sources
Reading File
Reading File
Reading File
Reading File
Reading File
Reading File
Finding Sources
Reading File
Reading File
Reading File
Reading File
Reading File
Reading File
I now have comprehensive material. Let me compile the full answer.
Wound vs. Cut - Types of Wounds - Management
1. Wound vs. Cut: What's the Difference?
A wound is any disruption of the normal continuity of body tissues caused by physical, mechanical, thermal, chemical, or electrical forces. It is the broad, general term.
A cut (incised wound) is one specific type of wound - a clean, linear division of soft tissue caused by a sharp-edged instrument (knife, scalpel, glass). So: every cut is a wound, but not every wound is a cut.
2. Classification of Wounds
Wounds are diverse and no single system covers all contexts. Multiple classification frameworks are used together:
A. By Mechanism / Causative Agent
(i) Blunt weapon (mechanical, blunt force):
| Type | Description |
|---|---|
| Contusion (Bruise) | Caused by blunt force without breaking skin. Blood extravasates into subcutaneous tissues. Size depends on force applied, tissue type, age, sex, and skin color. |
| Abrasion (Graze) | Skin scraped or rubbed; only the superficial epidermal layer is removed. Common in road traffic accidents. |
| Laceration | A tear in the skin from blunt trauma. Has irregular, ragged edges, tissue bridging, and crushed margins. Should not be confused with an incised wound. |
(ii) Sharp weapon (mechanical, sharp force):
| Type | Description |
|---|---|
| Incised wound (Cut) | Clean, linear wound from a sharp-edged instrument drawn across the skin. Edges are clean and well-defined; length > depth; bleeds profusely. |
| Stab wound (Puncture) | Produced by a pointed instrument thrust into the body. Depth > width; may injure deep structures with minimal surface appearance. |
(iii) Others:
- Firearm wounds - entry, exit, or graze
- Bite wounds - puncture or avulsion from teeth
- Burns - thermal, electrical, chemical, radiation
- Blast/Explosion wounds
- Degloving/Avulsion - skin and subcutaneous fat stripped from underlying fascia, muscle, or bone
B. By Contamination (CDC/Surgical Classification)
| Class | Type | Description |
|---|---|---|
| I | Clean | Uninfected operative wound, no inflammation, GI/respiratory/genital tract not entered |
| II | Clean-contaminated | GI/respiratory/genital tract entered under controlled conditions |
| III | Contaminated | Fresh traumatic wounds, major breaks in sterile technique, acute non-purulent inflammation |
| IV | Dirty/Infected | Old traumatic wounds, perforated viscera, clinical infection present |
(Bailey and Love's Short Practice of Surgery, 28th ed.)
C. By Depth
- Epidermal
- Dermal (superficial or deep)
- Full thickness (through all skin layers into subcutaneous fat, fascia, or deeper)
D. By Complexity
- Simple - involves skin only
- Complex - significant soft-tissue loss, open fracture or joint, visceral involvement
E. By Time Course
- Acute - traumatic wounds, surgical wounds - expected to heal within normal timeframes
- Chronic - fail to heal within expected time:
- Vascular ulcers (venous or arterial)
- Pressure ulcers
- Diabetic ulcers
F. By Complication Status
- Uncomplicated
- Complicated: infection, necrosis, haematoma, gas gangrene, compartment syndrome
3. Types of Wound Healing
| Type | Also Called | Description |
|---|---|---|
| Primary healing | 1st intention | Wound edges directly approximated; clean incisions; best scar outcome |
| Secondary healing | 2nd intention | Wound left open; heals by granulation, contraction, and re-epithelialisation; poor scar |
| Tertiary / Delayed primary | 3rd intention | Wound initially left open (contaminated or untidy), then edges surgically approximated once clean |
4. Wound Management
Step 1 - Assessment (2 marks worth)
Use ATLS principles - first identify life- and limb-threatening conditions.
Assess:
- Site, size, geometry, and nature of wound
- Signs of contamination, infection, swelling, pulsatile bleeding
- Skin loss or degloving
- Underlying structures visible (bone, tendon, nerve)
- Mechanism of injury (high-pressure injection, bites, etc.)
- Motor and sensory function before local anaesthesia
- Imaging if foreign body, fracture, or dislocation suspected
(Bailey and Love's, p. 49-51)
Step 2 - Key Management Principles (6+6 marks worth)
Preparation
- Analgesia / Anaesthesia - adequate pain control before wound exploration
- Antibiotic prophylaxis - required for clean-contaminated, contaminated, and dirty wounds; also for clean wounds with high infection risk
- Tetanus prophylaxis - assess immunisation status; tetanus-prone wounds include puncture injuries, bites, compound fractures, wounds with heavy contamination (soil/manure), burns with sepsis
Wound Treatment
- Haemostasis - direct pressure and elevation; topical agents (chitosan dressings, topical thrombin); vessel ligation/electrocautery if needed
- Irrigation - all wounds irrigated early with warm normal saline; reduces bacterial contamination; allows better visualisation
- Debridement - remove all devitalised tissue and foreign material until healthy bleeding at wound edges. Methods:
| Method | Detail |
|---|---|
| Surgical | Scalpel, scissors, curette until bleeding edges |
| Mechanical | Irrigation, wet-to-dry dressings (non-selective) |
| Autolytic | Hydrocolloid dressings retain moisture; wound enzymes liquefy necrotic tissue selectively |
| Enzymatic | Topical collagenase or papain-urea |
| Biological (Maggot therapy) | Lucilia sericata larvae release proteolytic and antimicrobial substances |
- Exploration - assess for neurovascular, tendon, joint, bone damage; repair under magnification (loupes/microscope) for nerves and vessels
Closure - Reconstruction Options
- Primary closure (tension-free)
- Secondary closure (leave open)
- Tertiary/delayed primary closure
- Negative Pressure Wound Therapy (NPWT)
- Split-thickness skin graft
- Full-thickness skin graft
- Dermal matrices
- Local, regional, or pedicled flap
- Tissue expansion
- Free flap (microsurgery)
Skin closure should always be without tension. Use the reconstructive ladder principle: start simple, escalate as needed.
Dressings
- Optimal dressings chosen based on wound type - dry, moist, absorbent, antimicrobial
- Negative pressure dressings for complex wounds
Follow-up
- Suture / splint removal at appropriate time
- Physiotherapy where indicated
- Monitoring for complications (infection, dehiscence, haematoma)
- Scar management
Factors Affecting Healing
| Local | Systemic |
|---|---|
| Skin tension | Advancing age |
| Hypoxia / ischaemia | Obesity |
| Vascular insufficiency | Malnutrition |
| Lymphoedema | Smoking |
| Contamination / infection | Diabetes mellitus |
| Foreign bodies | Connective tissue diseases |
| Radiotherapy | Immunocompromised state |
| Medications (steroids, immunosuppressants, chemotherapy) |
Sources
- Bailey and Love's Short Practice of Surgery, 28th Edition (Chapter 3: Wounds)
- P.C. Dikshit Textbook of Forensic Medicine and Toxicology (Chapter 13: Mechanical Injuries)
- Roberts and Hedges' Clinical Procedures in Emergency Medicine
- Robbins & Kumar Basic Pathology
What is burn? Different types of burn? Degree of burn? First aid of burn patient
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Reading File
Reading File
Reading File
Reading File
Reading File
Finding Sources
Reading File
Reading File
Reading File
Reading File
Finding Sources
Reading File
Reading File
Reading File
Reading File
I now have comprehensive content. Let me compile the full structured answer.
Burns: Definition, Types, Degrees, and First Aid
1. What is a Burn?
A burn is a tissue injury caused by transfer of energy to the body from thermal, chemical, electrical, or radiation sources. Burns cause a multisystem injury, but the skin is by far the most commonly and directly affected organ. Cell damage begins at temperatures above 45°C (113°F) due to denaturation of cellular proteins. The size and depth of a burn depend on the burning agent, its temperature, and the duration of exposure.
Burns cause three concentric zones of tissue injury:
- Zone of coagulation - innermost; tissue irreversibly destroyed with vessel thrombosis
- Zone of stasis - surrounding area; microcirculation stagnated; can become ischaemic if resuscitation is inadequate
- Zone of hyperemia - outermost; increased blood flow; minimal cell damage; likely to recover spontaneously
(Bailey and Love's, p. 686 | Tintinalli's Emergency Medicine)
2. Types of Burns (By Causative Agent)
| Type | Cause | Key Features |
|---|---|---|
| Thermal | Flame, scalds (hot water/steam), contact with hot surfaces | Most common; scalds common in children; flame burns in adults |
| Chemical | Acids, alkalis, corrosives | Alkalis penetrate deeper and cause continuing injury; requires prolonged irrigation |
| Electrical | Electrical current (AC/DC), lightning | Entry and exit wounds; deep tissue destruction often out of proportion to skin appearance; may cause rhabdomyolysis and renal failure |
| Radiation | UV light (sunburn, arc welding), X-rays, nuclear | UV burns cause keratitis; nuclear/X-ray burns cause deep radiation injury |
| Friction | Skin rubbing against rough surfaces | Combination of abrasion and heat |
| Cold (Frostbite) | Extreme cold exposure | Rare thermal injury; also causes tissue destruction |
Note: The majority of electrical and chemical burns occur in adults and are frequently work-related. Burns in the elderly are commonly contact burns (falls against radiators).
3. Degrees of Burn (Burn Depth Classification)
Originally classified by Dupuytren (1832) into degrees. The modern functional classification (used in burn centers) also describes burns as superficial partial-thickness, deep partial-thickness, and full-thickness - based on the need for surgical intervention.
| Degree | Also Called | Depth | Clinical Features | Example | Healing |
|---|---|---|---|---|---|
| 1st degree | Superficial | Epidermis only | Red, dry, painful, no blisters | Sunburn | ~7 days, no scar |
| 2nd degree (superficial) | Superficial partial-thickness | Epidermis + superficial (papillary) dermis | Blisters, very painful, red, weeping, blanches on pressure | Hot water scald | 14-21 days, no permanent scar |
| 2nd degree (deep) | Deep partial-thickness | Epidermis + deep dermis, sweat glands, hair follicles | Blisters, painful, mottled, moist | Hot liquid, steam, grease, flame | 3-8 weeks, permanent scar |
| 3rd degree | Full-thickness | Entire epidermis and dermis destroyed | Charred, pale/white, leathery; painless (nerve endings destroyed) | Flame, prolonged contact | Months; severe scarring; skin grafts necessary |
| 4th degree | Sub-dermal | Through skin into fat, muscle, and/or bone | Devastating, life-threatening | High-voltage electricity, incineration | Months; multiple surgeries; may need amputation |
5th and 6th degrees are sometimes described in specialist contexts for burns involving underlying viscera or through extremities.
(Tintinalli's Emergency Medicine, Table 217-2 | Schwartz's Principles of Surgery | Bailey and Love's)
4. Assessment of Burn Size
Rule of Nines (Adults)
Divides body into areas of ~9%:
- Head and neck: 9%
- Each arm: 9% (x2 = 18%)
- Anterior trunk: 18%
- Posterior trunk: 18%
- Each leg: 18% (x2 = 36%)
- Perineum: 1%
- Total = 100%
Lund-Browder Diagram
More accurate - accounts for age-related anatomical differences in children (proportionally larger head, smaller legs).
Palm Method
The area of the back of the patient's own hand = approximately 1% TBSA - useful for irregular burns.
5. First Aid (Prehospital Care) of a Burn Patient
(Bailey and Love's, p. 687-688 | Tintinalli's)
Step-by-Step First Aid:
1. Ensure rescuer safety first
- Particularly important for electrical injuries (switch off power), chemical burns, and building fires before approaching the patient.
2. Stop the burning process
- "Stop, drop and roll" to extinguish flames on a person.
- Remove burning/smouldering clothing and jewellery (unless stuck to skin).
- For chemical burns: brush off dry chemicals first, then irrigate copiously with water.
- For electrical burns: ensure power is isolated before touching the patient.
3. Cool the burn
- Apply cool running water at approximately 15°C (tepid water) for 20 minutes.
- Effective up to 1 hour after the burn injury.
- Particularly important for partial-thickness burns and scalds.
- Do NOT use ice water - causes vasoconstriction and worsens injury.
- Avoid hypothermia, especially in children and the elderly - use cool water only on the burned area, keep rest of body warm.
- Do NOT apply butter, toothpaste, oil, or other home remedies.
4. Cover the wound
- Apply a clean, non-fluffy dressing or cling film (plastic wrap) loosely over the burn.
- Cling film is ideal: non-adherent, transparent (allows assessment), and reduces pain from air contact.
- Do NOT burst blisters in the field.
5. Airway - give oxygen
- Anyone exposed to smoke in an enclosed space should receive 100% oxygen by non-rebreather mask.
- Signs of airway involvement: hoarse voice, stridor, singed nasal hairs, perioral burns, blistering inside the mouth - these indicate risk of rapid airway oedema.
- Sit the patient upright if airway burn is suspected - may be life-saving while awaiting transfer.
6. Elevate burned limbs
- Reduces swelling and discomfort.
7. Analgesia
- Administer analgesia before or during transfer to hospital to alleviate pain.
8. ABC check and transfer
- Perform an ABC (Airway-Breathing-Circulation) assessment.
- Check for coexisting injuries (blast, fall, fractures).
- Transfer urgently to hospital / burn unit.
6. When to Transfer to a Burn Unit
(American Burn Association / Bailey and Love's)
- Full-thickness (3rd degree) burns - any age
- Partial-thickness burns > 10% TBSA (children > 15%)
- Burns of the face, hands, feet, genitalia, perineum, or crossing major joints
- Electrical burns (including lightning)
- Chemical burns
- Inhalation injury
- Burns with concurrent trauma
- Extremes of age: children < 10 years, adults > 50 years
- Burns with significant comorbidities (diabetes, cardiac disease, immunosuppression)
- Any suspicion of non-accidental injury
7. Fluid Resuscitation (Parkland Formula)
For burns > 20% TBSA:
Adults: Lactated Ringer's = 4 mL × weight (kg) × % TBSA burned
- Half given over first 8 hours from time of burn
- Other half over the next 16 hours
Children: 3 mL × weight (kg) × % TBSA + maintenance fluids
Target urine output: 0.5-1.0 mL/kg/h
Sources
- Bailey and Love's Short Practice of Surgery, 28th Edition (Chapter 46: Burns)
- Tintinalli's Emergency Medicine, A Comprehensive Study Guide (Chapter 217)
- Schwartz's Principles of Surgery, 11th Edition
- Current Surgical Therapy, 14th Edition
- Schwartz's Key Points: Early excision and grafting of full-thickness and deep partial-thickness burns improves outcomes
This is a shared conversation. Sign in to Orris to start your own chat.