Wound
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Wound

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Wound

A wound (/ˈwnd/) is any disruption of or damage to living tissue, such as skin, mucous membranes, or organs. Wounds can either be the sudden result of direct trauma (mechanical, thermal, chemical), or can develop slowly over time due to underlying disease processes such as diabetes mellitus, venous/arterial insufficiency, or immunologic disease. Wounds can vary greatly in their appearance depending on wound location, injury mechanism, depth of injury, timing of onset (acute vs chronic), and wound sterility, among other factors. Treatment strategies for wounds will vary based on the classification of the wound, therefore it is essential that wounds be thoroughly evaluated by a healthcare professional for proper management. In normal physiology, all wounds will undergo a series of steps collectively known as the wound healing process, which include hemostasis, inflammation, proliferation, and tissue remodeling. Age, tissue oxygenation, stress, underlying medical conditions, and certain medications are just a few of the many factors known to affect the rate of wound healing.

Wounds can be broadly classified as either acute or chronic based on time from initial injury and progression through normal stages of wound healing. Both wound types can further be categorized by cause of injury, wound severity/depth, and sterility of the wound bed. Several classification systems have been developed to describe wounds and guide their management. Some notable classification systems include the CDC's Surgical Wound Classification, the International Red Cross Wound Classification, the Tscherne classification, the Gustilo-Anderson classification of open fractures, and the AO soft tissue grading system.

An acute wound is any wound which results from direct trauma and progresses through the four stages of wound healing along an expected timeline. The first stage, hemostasis, lasts from minutes to hours after initial injury. This stage is followed by the inflammatory phase which typically lasts 1 to 3 days. Proliferation is the third stage of wound healing and lasts from a few days up to a month. The fourth and final phase of wound healing, remodeling/scar formation, typically lasts 12 months but can continue as long as 2 years after the initial injury. Acute wounds can further be classified as either open or closed. An open wound is any injury whereby the integrity of the skin has been disrupted and the underlying tissue is exposed. A closed wound, on the other hand, is any injury in which underlying tissue has been damaged but the overlying skin is still intact.

Fractures can be classified as either open or closed, depending on whether the integrity of the overlying skin has been disrupted or preserved, respectively. Several classification systems have been developed to further characterize soft tissue injuries in the setting of an underlying fracture:

Any wound which is arrested or delayed during any of the normal stages of wound healing is considered to be a chronic wound. Most commonly, these are wounds which develop due to an underlying disease process such as diabetes mellitus or arterial/venous insufficiency. However, it is important to note that any acute wound has the potential to become a chronic wound if any of the normal stages of wound healing are interrupted. Chronic wounds are most commonly a result of disruption of the inflammatory phase of wound healing, however errors in any phase can result in a chronic wound. The exact duration of time which distinguishes a chronic wound from an acute wound is not clearly defined, although many clinicians agree that wounds which have not progressed for over three months are considered chronic wounds.

Wound sterility, or degree of contamination of a wound, is a critical consideration when evaluating a wound. In the United States, the CDC's Surgical Wound Classification System is most commonly used for classification of a wound's sterility, specifically within a surgical setting. According to this classification system, four different classes of wound exist, each with their own postoperative risk of surgical site infection:

Wound presentation will vary greatly based on a number of factors, each of which is important to consider in order to establish a proper diagnosis and treatment plan. In addition to collecting a thorough history, the following factors should be considered when evaluating any wound:

A thorough wound evaluation, particularly evaluation of wound depth and removal of necrotic tissue, should be performed only by a licensed healthcare professional in order to avoid damage to nearby structures, infection, or worsening pain.[citation needed]

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