When To Not Close A Wound

Reviewed on 10/22/2020

Wounds should not be closed in the following conditions

  • Wounds with high chances of infection should be kept open for greater than 24 hours or should not be stitched for adequate cleaning and antibiotic treatment to prevent the risk of infection.
  • Contaminated and infected wounds should be kept open to heal by secondary intention
  • Clean wounds, contaminated wounds, or clean wounds that are more than 6 hours old should be closed 48 hours later
  • Wounds with significant tissue loss
  • Wounds caused by an animal or human bites should not be immediately covered to prevent florid infection
  • Abrasion that occurs when the skin rubs or scratches against a hard surface should be scrubbed and cleaned to avoid infection.
  • Cuts that are less than half-inch long and are not wide open

How can wounds be classified?

Depending on the time of healing, the wounds can be

  • Acute: Wounds that heal without any events in a short period.
  • Chronic: Wounds that may have complications and take longer to heal.

Depending on the exposure of the underlying tissue, they can be classified as

  • Open: The internal tissues are exposed.
  • Closed: The internal tissues and organs are not exposed.

Wounds can be either internal or external. The causes of internal wounds are

  • Impaired immune and nervous system function.
  • A decreased supply of blood and oxygen to a particular area.

External wounds can be caused by

  • Penetrating objects
  • Nonpenetrating trauma
  • Other miscellaneous causes

Non-penetrating wounds

These are usually caused due to blunt injury or friction with other surfaces and may include

  • Cuts, lacerations, gashes, and tears: These are wounds caused due to sharp objects. It may go through the skin to the fat tissue.
  • Scrapes, abrasions, scratches, and floor burns: These types of wounds occur when the skin rubs or scratches against a hard surface.
  • Bruises: Wounds that result in bleeding under the skin due to the damaged blood vessels. It is caused by blunt objects and can occur without a cut or scrape.
  • Contusions: Swollen bruises due to the pooling of blood and dead cells under the skin. These are larger in size than bruises.
  • Concussions: Damage to underlying organs and tissue on the head with no visible external wound (blunt trauma).

Penetrating wounds

These result from the trauma that penetrates through the full thickness of skin to the underlying tissue and organs. These may include

  • Stab wounds: Injury from sharp objects, such as knives.
  • Skin cuts
  • Surgical wounds: Intended cuts in the skin to carry out a surgical procedure.
  • Gunshot wounds: Wounds resulting from firearms.

Miscellaneous wounds include

  • Thermal wounds: Extreme temperatures, both hot and cold, can result in injuries (burns, sunburns, and frostbite).
  • Chemical wounds: Contact with or inhalation of chemical materials can result in skin or lung injury.
  • Bites and stings: Bites resulting from humans, dogs, bats, rodents, snakes, spiders, and ticks can result in skin injury.
  • Electrical wounds: Passage of high-voltage electrical currents through the body can result in superficial burn-like or sting-like wounds and severe internal damage.

Surgical wounds are classified as

  • Clean
  • Clean and contaminated: A normal wound, but a colonized tissue.
  • Contaminated: A wound containing foreign material.
  • Infected: A wound with pus.

What are the factors that affect wound healing?

Factors that affect wound healing and the potential of infection include

  • Age
  • Underlying diseases
  • Blood supply to the affected part
  • Presence of a foreign body in the wound
  • Injured organ or tissue
  • The intensity of the injury
  • Characteristics of injury
  • Contamination or infection
  • The duration between trauma and treatment

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References
https://www.who.int/surgery/publications/WoundManagement.pdf

https://www.ncbi.nlm.nih.gov/books/NBK470598/

https://www.woundcarecenters.org/article/wound-basics/different-types-of-wounds

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