WOUND CLASSIFICATION

AIM:

Wound classification systems provides frameworks that:-

 Aid diagnosis and stratification

 Ensure uniformity of documentation
 Offer prognostic information
 Guide management

TYPES OF WOUND CLASSIFICATION

Wounds can be classified as follows:-

 According to the etiology

 According to Rank-Wakefield classification system
 According to the duration of the wound
 According to the integrity of the skin
 According to wound depth
 According to morphological characteristics
 According to degree of contamination
 According to severity
 According to the apperance of wound
 Based on the origin
 According to the type of wound healing

 ACCORDING TO THE ETIOLOGY

 Surgical wound
These are wounds caused by surgical procedure
 Penetrating wound
Wounds caused by penetrating trauma
 Blunt wound
Wounds caused by blunt trauma
 Burn wound
Wounds caused by burn injuries

 ACCORDING TO RANK-WAKEFIELD CLASSIFICATION SYSTEM

 Tidy wounds
 These are wounds inflicted by sharp instruments and contain no devitalized tissue.
 Such wounds can be closed primarily with the expectation of quite primary healing
 They are usually single with clean cut
 Associated fractures are uncommon in tidy wounds
 Examples: surgical incisions, cuts from glass and knife wounds
 Untidy wounds
 These are wounds resulting from crushing, tearing avulsion, vascular injury or burns,
and contain devitalized tissue
 They are usually multiple and irregular
 Commonly associated with fractures
 Such wounds cannot be closed primarily and therefore should be allowed to heal by
second intention

 ACCORDING TO THE DURATION OF WOUND

 Acute wounds
 Acute wounds are wounds that usually heal in the anticipated time frame
 Duration of the wound: immediately to few weeks
 Examples are wounds acquired as a result of trauma or an operative
procedure
 Chronic wounds
 Wounds that fail to heal in the anticipated time frame and often reoccur
Duration of the wound ⇒> 4 weeks to 3 months
 Wounds occur as a result of an underlying condition such as extended
pressure on the tissues, poor circulation, or even poor nutrition
 Pressure ulcers, venous leg ulcers, and diabetic foot ulcers are examples.

 ACCORDING TO THE INTEGRITY OF THE SKIN

 Open wounds
 Type of wounds in which the skin has been compromised and underlying
tissues are exposed
 Open wounds can be classified into a number of different types, according to
the object that caused the wound
 Examples include incised wounds, laceration, punctured wounds etc

FIG 3: OPENWOUND

 Closed wounds
 Wounds in which the skin has not been compromised, but trauma to
underlying structures has occurred
 Closed wounds have fewer categories, but are just as dangerous as
open wounds
 Examples of closed wounds are:
• Contusions - (more commonly known as a bruise) - caused by blunt
force trauma that damages tissue under the skin
 • Hematoma - (also called a blood tumor) - caused by damage to a
blood vessel that in turn causes blood to collect under the skin

FIG 4 BRUISES

 ACCORDING TO WOUND DEPTH

 Superficial wounds
 Only the epidermis is affected and has to be replaced
 A truly superficial wound does not bleed and heals within a few days
 Examples include most abrasions and blisters

 Partial-thickness wounds
 The epidermis and part of the dermis is affected
 A partial-thickness wound does bleed If left uncovered, a blood clot will cover the wound
and a scar will form
 The missing tissue will then be replaced, followed by regeneration of the epidermis
 A partial-thickness wound can take from several days to several weeks to heal, depending
on the patient and the wound treatments chosen

 Full-thickness wounds
 A full-thickness wound involves the epidermis and the dermis
 The underlying fatty tissue, bones, muscles, or tendons may also be damaged
 If full-thickness wounds cannot be sutured, the healing process will create new tissue to fill
the wound, followed by regeneration of the epidermis
 The full-thickness wound takes longer time to heal than does a partial-thickness wound,
sometimes as long as several months

 ACCORDING TO MORPHOLOGICAL CHARACTERISTICS

 Bruises / contusion
 These are closed wounds
 Caused by blunt trauma that damage the tissue under the skin without breaking the
skin
 Characterized by skin discoloration due to bleeding into the tissues
 Blows to the chest, abdomen, or head with a blunt instrument can cause contusions

 Hematoma
  These are also closed wounds caused by damage to a blood vessel that in turn
causes blood to collect under the skin
 Initially this is fluid, but it will clot within minutes or hours ⇒later after few days
the hematoma will again liquefy → increased risk of secondary infection → pus
formation

 Crush wounds
 Crush wounds are caused by a great or extreme amount of force applied over a long
period of time
 These occur when a heavy object falls onto a person, splitting the skin and shattering
or tearing underlying structures
 They are often accompanied by degloving injuries and compartment syndrome

 Abrasions
 An abrasion is a shearing injury of the skin I which the surface is rubbed off
 Most are superficial and will heal by epitheliazation

 Lacerated wound
 Caused by tearing of tissues
 Wounds have irregular borders
 Loss of tissue is limited to skin and s/c tissue

 Penetrated wound
 Cause by sharp pointed objects like nails
 Have relatively small opening
 May be very deep
 Infection/ foreign particles might have been carried deep in to wound
opening is inadequate for drainage eg: punctured wound on foot due t
gathered nail

 Perforating wound
 Have two opening one of entrance and other of exit
 E.g. gunshot wounds

 ACCORDING TO THE BACTERIAL CONTAMINATION

 Clean wounds
 No break in aseptic technique
 Incision is made under sterile condions
 No inflammation is encountered
 The respiratory tract, alimentary, genital or uninfected urinary tracts are not entered
 Primary closure
 Eg Herniorrhaphy

 Clean contaminated wounds

  Operative wounds in which the respiratory, alimentary, genital or urinary tract is
entered under controlled conditions and without unusual contamination

 Contaminated wounds
 Open, fresh or accidental wounds; operations with major breaks in sterile technique
or gross spillage from the gastrointestinal tract; and incisions in which acute, non-
purulent inflammation is encountered

 Heavily contaminated wounds

 Old traumatic wounds with retained devitalized tissue and those that involve existing
clinical infection

 ACCORDING TO SEVERITY

 Simple wounds
The integrity of the skin is traumatized without loss or destruction of tissue and
without the presence of a foreign body in the wound

 Complex wounds
Tissue is lost or destructed by means of a crush, burn, or foreign body in the wound

 ACCORDING TO THE APPERANCE OF WOUND

WOUND TYPE WOUND APPEARENCE WOUND COLOUR

TYPE N Necrotic area of dead tissue BLACK
TYPE S Slough, dead cells in exudate YELLOW
TYPE M/I Malodorous and or infected GREEN
TYPE G Granulation tissue RED
TYPE E Epithelialisation PINK

 BASED ON THE ORIGIN

I. MECHANICAL:

1. Abraded wound (vulnus abrasum)

2. Puncured wound (v. punctum)
3. Incised wound (v. scissum)
4. Cut wound (v. caesum)
5. Crush wound (v. contusum)
6. Bite wound (v. morsum)
7. Shot wound (v. sclopetarium)

FIG 5:GUNSHOT WOUND FIG 6:CRUSH INJURY

FIG 7:SURGICAL INCISION WOUND FIG 8:ABRASION

II. CHEMICAL:

1. Acid
2. Base

FIG 9:CHEMICAL BURN

III. WOUNDS CAUSED BY RADIATION

FIG 10:RADIATION INJURY

IV. WOUNDS CAUSED BY THERMAL FORCES:

1. Burning
 2. Freezing

FIG 11:FROST BITE

V. SPECIAL

Wounds caused by exotic, poisonous animals

 ACCORDING TO THE TYPE OF WOUND HEALING

•HEALING BY PRIMARY INTENTION:

All Layers are closed. The incision that heals by first intention does so in a minimum amount of time,
with no separation of the wound edges, and with minimal scar formation.

•HEALING BY SECONDARY INTENTION:

Deep layers are closed but superficial layers are left to heal from the inside out. Healing by second is
appropriate in cases of infection, excessive trauma, tissue loss, or imprecise approximation of tissue.

•HEALING BY TERTIARY INTENTION:

Also referred to as delayed primary closure. Wound is initially left open. It is a useful option for
managing wounds that are too heavily contaminated for primary closure but has appearance of clean
wound. The wound will be well vascularized after 4 to 5 days of open observation so that the
cutaneous edges can be approximated at that time.