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Also found in:DictionaryThesaurusLegalIdiomsEncyclopediaWikipedia.Related to wound:Wound InfectionWound CareWound healing?Note: This page may contain content that is offensive or inappropriate for some readers.an injury or damage, usually restricted to those caused by physical means with disruption of normal continuity of structures. Called alsoinjuryandtrauma.any device by which a channel or open area may be established for the exit of material from a wound or cavity. See alsorestoration of integrity to injured tissues by replacement of dead tissue with viable tissue; this starts immediately after an injury, may continue for months or years, and is essentially the same for all types of wounds. Variations are the result of differences in location, severity of the wound, extent of injury to the tissues, the age, nutritional status, and general state of health of the patient, and available body reserves and resources for tissue regeneration.

The repair of damaged cells and tissue takes place byregeneration, in which structures are replaced by proliferation of similar cells, such as happens with skin and bone; and by formation of ascar, consisting of fibrous structures with some degree of contraction. Since most wounds extend to more than one type of tissue, complete regeneration is impossible; therefore, scar formation is an expected outcome of wound healing.

Inhealing by first intention(primary union), restoration of tissue continuity occurs directly, without granulation; inhealing by second intention(secondary union), wound repair following tissue loss (as inulceration) is accomplished by closure of the wound with granulation tissue. This tissue is formed by proliferation offibroblastsand extensive capillary budding at the outer edges and base of the wound cavity, with slow extension from the base and sides of the wound toward its center. If, however, the wound is very deep and extensive, granulation tissue cannot fill the defect andgraftingmay be needed to cover the space and avoid severe contracture and loss of function.healing by third intention(delayed primary closure) occurs when a wound is initially too contaminated to close and is closed surgically 4 or 5 days after the injury. (See also illustrations athealing.)

The insertion ofdrainscan facilitate healing by providing an outlet for removing accumulations of serosanguineous fluid and purulent material, and obliterating dead space such as that created by surgical removal of an organ.

If the area of injury is not very large, the products of inflammation, smallbloodclots, and other debris from the wound can be absorbed into the blood stream and disposed of. Wounds that are filled with large amounts of dead cells, blood clots, and other debris must be cleansed in order for healing to take place. This can be accomplished by surgical or chemicaldbridementor byirrigations. Enzymes are sometimes used to remove the debris by enzymatic action. Since foreign bodies, such as sutures, slivers of glass, splinters, and the like, can delay healing, they too must be removed from the wound to facilitate healing.Patient Care. Assessment of the progress of wound healing begins with frequent inspection of the site for signs of bleeding in or around the wound. Discoloration of the skin adjacent to a surgical or traumatic wound that has been sutured may indicate a pooling of blood in the tissue spaces and the beginning stages of ahematoma. Bleeding in a wound and clot formation can delay healing. Accumulations of serosanguineous fluid and purulent drainage also must be watched for, because they retard the healing process and pose a problem ofsuperinfection. If adrainhas been inserted to remove excess fluid, the color, amount, odor, and other characteristics of the drainage must be noted and recorded. If there is more than one drain, the drainage from each should be noted separately.

Dressings also must be observed frequently, especially apressuredressing, which can become dangerously restrictive if there is swelling. Any change in sensation, such as tingling or numbness, signs of impaired circulation, or complaint of discomfort, should be reported to the physician.

Other data important to the ongoing assessment of wound healing are theleukocytecount,coagulationtests, andelectrolytelevels. An elevated body temperature can signal local or systemic infection. Another sign of infection is the presence of purulent drainage. The color of the drainage is often indicative of the particular infecting organism. For example, a yellow color may indicate presence ofStaphylococcusaureus,and a blue-green color may indicatePseudomonasaeruginosainfection.

In a surgical wound, a discharge of serosanguineous fluid on the fourth or fifth postoperative day may signalwounddehiscenceand, therefore, should be reported immediately to the surgeon.

During the scarring phase of healing, the wound is inspected for changes in size, color, and shape, which can continue for months even in superficial wounds. New scar tissue is usually purplish, raised, and irregular. With time, the color fades, the scar grows smaller, and its surface and edges become less irregular. Sometimes the scar tissue grows to excess and extends beyond the normal limits of the wound. This hypertrophic scar orkeloidmay require steroid injections or surgical removal.

In order to achieve adequate and uneventful healing of a wound the patient must be in a good state of nutrition. Virtually every nutrient plays some role in the healing process; hence, a wide range of dietary nutrients must be supplied, either through oral feedings, supplemental vitamins and protein, orparenteral nutrition. Oxygen is also essential to the healing process. This means that measures must be taken to ensure adequate circulation of blood to the wound, employing measures such as exercise, ambulation when possible, and applications of warmth when prescribed. Positioning also is important to avoid prolonged pressure against blood vessels serving the wounded area. Adequate rest is needed to facilitate healing. The patient should understand the need for rest and the purpose of splints, casts, and other devices employed for immobilization of a wounded part.

Mechanical injury to a wound can greatly impede healing by damaging the tissues involved in the healing process. The wound should be protected from friction and direct blows. The affected part must be handled gently, and great care must be used in applying and removing dressings and bandages. Protective bandages and shields made from rubber, plastic cups, tongue blades, and other supportive materials may be needed to protect the wound from additional trauma.

Other factors that work against optimal healing are stress, old age, smoking, obesity, and diabetes mellitus. It is thought that in the poorly controlled diabetic patient there is an increased affinity of hemoglobin for oxygen, which hampers the release of oxygen to the healing tissues. Additionally, poorly controlled diabetic patients have an abnormal function of the phagocytes, which predisposes wounds to infection. Although cancer does not itself interfere with the healing process or make the patient more susceptible to infection,radiation therapy,steroids, and antineoplasticagents, as well as the general debility of the patient, do compromise healing in cancer patients.Wound dressing construction and design. From Cohen et al., 1992.incised woundone caused by a cutting instrument.lacerated woundone in which the tissues are torn.open woundone that communicates directly with the atmosphere.penetrating woundone caused by a sharp, usually slender, object that passes through the skin into the underlying tissues.perforating woundapenetrating woundthat extends into a viscus or bodily cavity.puncture woundpenetrating wound.sucking woundapenetrating woundof the chest through which air is drawn in and out, as in openpneumothorax.tangential woundan oblique glancing wound that results in one edge being undercut.Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.wound(wnd),1.Trauma to any of the tissues of the body, especially that caused by physical means and with interruption of continuity.2.A surgical incision.3.To inflict with a wound.[O.E.wund]Farlex Partner Medical Dictionary © Farlex 2012wound(woond)n.1.An injury to an organism, especially one in which the skin or another external surface is torn, pierced, cut, or otherwise broken.2.An injury to the feelings.v.wounded,wounding,woundsv.tr.To inflict wounds or a wound on.v.intr.To inflict wounds or a wound:harsh criticism that wounds.woundedlyadv.woundinglyadv.The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.woundMedtalk An injury caused by physical means. SeeClean woundDefense wound, Dirty wound,Entrance woundExecution woundExit woundHesitation woundProblem wound.McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.wound(wnd)1.Trauma to any of the tissues of the body, especially that caused by physical means and with interruption of continuity.2.A surgical incision.[O.E.wund]Medical Dictionary for the Health Professions and Nursing © Farlex 2012wound(woond)A break in the continuity of body structures caused by violence, trauma, or surgery to tissues. In treating the nonsurgically created wound, tetanus prophylaxis must be considered. If not previously immunized, the patient should be given tetanus immune globulin.Patient care

Successful wound assessment relies on a thorough, organized approach. This assessment includes the wounds location, size, depth, undermining, drainage, wound edges, base, and surrounding tissues. Include an assessment for any redness, swelling, tenderness, and gangrene/necrosis. The assessment includes the patients vital signs and measures used, which improve the wound healing. The assessment includes the patients vital signs and measures taken to improve the wound healing. Multiple diagnostic modalities (such as radiographic studies) may be employed to further delineate the extent of the injury.

A traumatic injury or surgical incision which may be superficial or extend to intraperitoneal or extraperitoneal organs or tissues. In cases of abdominal trauma, a careful examination (often including peritoneal lavage, ultrasonography, or computed tomographic scanning of the abdomen) is necessary to determine the precise nature of the injury and the proper course of treatment. Superficial injuries may require no more than ordinary local care; immediate laparotomy may be needed, however, when major bleeding or organ damage has occurred. Intravenous fluids, blood components, antibiotics, and tetanus prophylaxis are given when necessary. Major abdominal trauma may be overlooked in comatose or otherwise critically injured patients when there is no obvious abdominal injury. See:abdomen

A penetrating wound caused by a missile discharged from a firearm. The extent of injury depends on the wound site and the speed and character of the bullet.gunshot wound

Tetanus booster injection or tetanus immune globulin and antibiotics, if indicated, should be given. An appropriate bandage should be applied. Emergency surgery may be necessary. Complications, including hemorrhage and shock, should be treated.

A bruise in which the skin is not broken. It may be caused by a blunt instrument. Injury of the tissues under the skin, leaving the skin unbroken, traumatizes the soft tissue. Ruptured blood vessels underneath the skin cause discoloration. If extravasated blood becomes encapsulated, it is termed hematoma; if it is diffuse, ecchymosis. See:ecchymosishematoma

Cold compresses, pressure, and rest, along with elevation of the injured area, will help prevent or reduce swelling. When the acute stage is over (within 24 to 48 hr), continued rest, heat, and elevation are prescribed. Aseptic drainage may be indicated.

An injury caused by a fishhook becoming embedded in soft tissue. Deeply embedded fishhooks are difficult to remove. One should push the hook through, then cut off the barb with an instrument, and pull the remainder of the fishhook out by the route of entry. Antitetanus treatment should be given as indicated. Because these injuries often become infected, prophylactic use of a broad-spectrum antibiotic is indicated.

A penetrating injury from a bullet shot from a gun. At very close range, the wound may have gunpowder deposits and the skin burn marks. GSWs can crush, penetrate, stretch, cavitate, or fracture body structures. The severity of the wound may depend on the structures damaged, the velocity and caliber of the bullet, and the underlying health of the victim. See:bullet woundknuckle woundAny injury to the metacarpal bones, esp. one that results from a fist fight. These wounds commonly include fractures and penetrating injuries contaminated with oral or periodontal bacteria.Synonym:knuckle tooth woundknuckle tooth woundKnuckle wound.lacerated woundLaceration.nonpenetrating woundBlunt trauma.OPEN WOUND: An open cavitary woundopen woundA contusion in which the skin is also broken, such as a gunshot, incised, or lacerated wound.See:illustrationpenetrating woundA wound in which the skin is broken and the agent causing the wound enters subcutaneous tissue or a deeply lying structure or cavity.perforating woundAny wound that has breached the body wall or internal organs. The perforation may be partial or complete.puncture woundA wound made by a sharp-pointed instrument such as a dagger, ice pick, or needle. A puncture wound usually is collapsed, which provides ideal conditions for infection. The placement of a drain, antitetanus therapy or prophylaxis, and gas gangrene prophylaxis may be required. This will depend on the nature of the instrument that caused the injury.subcutaneous woundA wound, such as contusion, that is unaccompanied by a break in the skin.sucking chest woundA wound that penetrates the thorax and draws air into the pleural cavity, usually resulting in an expanding pneumothorax.tunnel woundA wound having a small entrance and exit of uniform diameter.Medical Dictionary, © 2009 Farlex and PartnerswoundAny injury involving a break in the surface of the skin or an organ by any means including surgical incision.Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005WoundAny injury that breaks the skin, including cuts, scratches, and puncture wounds.Mentioned in:TetanusGale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.wound(wnd)1.Trauma to any body tissues, especially caused by physical means and with interruption of continuity.2.A surgical incision.3.To inflict with a wound.[O.E.wund]Medical Dictionary for the Dental Professions © Farlex 2012

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