Wound classification
Wounds are divided into several groups based on various criteria:
- By cause: surgical, accidental (traumatic), and combat-related.
- By number: single and multiple.
- By localization: neck, head, extremities, abdomen, pelvis, chest.
- By type of tissue: soft tissue, bone, brain, as well as those involving nerve, vascular, or tendon damage.
- By the course of the wound tract: through-and-through, blind, tangential, penetrating, or non-penetrating.
- By morphology: incised, stab, chop, contused (lacerated, mangled), scalped, bite wounds, and mixed.
Features of gunshot wounds
Gunshot injuries are particularly severe due to the impact of the shock wave and the kinetic energy of the projectile. Three zones are formed in such a wound:
- Wound tract zone: the defect itself with potential blind pockets.
- Zone of primary necrosis (contusion): tissues destroyed at the moment of trauma, representing an ideal medium for bacteria.
- Zone of molecular concussion (secondary necrosis): tissues with impaired viability that may either recover or perish.
Phases of the wound healing process
Healing proceeds through regular stages:
- Inflammatory phase. Begins with a vascular reaction (brief spasm followed by sustained dilation, increased permeability, and edema). Leukocyte migration occurs (neutrophils in the first days for phagocytosis and proteolysis, followed by macrophages and lymphocytes). It concludes with lytic cleansing of the wound.
- Proliferative phase. On days 6–7, granulation tissue forms. The main roles are played by fibroblasts, endothelium, and plasma cells, which synthesize the connective tissue matrix.
- Scarring phase. The number of cells and vessels decreases, and the volume of collagen fibers increases.
Types of healing and surgical treatment
A wound can heal in two ways:
- By primary intention: the edges are in contact, with no necrosis, hematomas, or significant infection. A thin scar forms by days 6–7.
- By secondary intention: the wound is first cleansed of purulent-necrotic masses, then fills with granulations, epithelizes, and scars.
The main treatment method is primary surgical wound care (primary debridement). Its goal is to prevent suppuration. During the procedure, the wound is inspected, dead tissue, foreign bodies, and hematomas are removed, bleeding is stopped, drainage is established, and anatomical structures are restored whenever possible.
Class and exam questions
What role do neutrophils play in the first phase of the wound process?
They perform phagocytosis of microbes and extracellular proteolysis, which is necessary to cleanse the wound of necrotic tissue.
What is primary surgical wound care?
Primary surgical wound care is a set of surgical measures (exploration, removal of non-viable tissue, hemostasis, drainage) for the prevention of wound suppuration.
What else to study on this topic
- Soft tissue, scar, and musculotendinous apparatus surgeries
- Myolysis, tenolysis, and neurolysis
- Types of skin grafting
- Tenodesis and tendon transposition
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Other topics in the section "General Questions of Traumatology and Orthopedics"
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