Skin Wounds Classification

Layers of the skin: Epidermis: most superficial layer prevents the entry of foreign substances Dermis: middle layer contains blood vessels, hair follicles, sweat glands and nerves Subcutaneous: deepest layer of skin fatty tissue conserves body’s heat and protects from injury 2

Soft Tissue Injuries Trauma that happens to the skin is visually exposed Categorized as a skin wound: Abrasion Laceration Avulsion Puncture Contusion Blister

Abrasion Skin scraped against a rough surface Several layers of skin are torn loose or totally removed Usually more painful than a deeper cut b/c scraping of skin exposes millions of nerve endings

Abrasion—Treatment Control bleeding using pressure Wash wound to remove all dirt and debris Soap and water or hydrogen peroxide Scrub wound if anything is embedded Leave open to air, unless oozing of fluid or blood Apply antibiotic ointment to prevent infections Keep clean

Abrasion—Treatment Loose skin flaps my form natural dressing; if flap is dirty then remove Watch for signs of infection Seek medical attention if any of following: Pain increases after several days Redness/red streaks appear beyond edges of wound Persistent drainage Drainage=yellow, green, or bloody, foul-smelling pus

Laceration(shallow)

Laceration(deep)

Laceration Flesh irregularly torn or cut in the skin Cuts less than 1/4” deep and have smooth edges can be treated at home (steri strips) Deeper lacerations should be treated by physician (stitches)

Laceration—Treatment Control bleeding using pressure Clean with soap and water Irrigate with clean water to remove debris Do NOT use alcohol, iodine, or peroxide as it may cause further damage and slow healing process Cover wound with antibiotic and sterile gauze For uncontrolled bleeding, seek immediate professional medical attention Lacerations that are superficial (do not involve fat or muscle tissue), are not bleeding heavily, less than 1/2 inch long and do not involve the face can usually be managed at home without stitches. The goals of caring for a wound are to stop the bleeding and reduce the chance of scarring and infection in the wound.

Laceration—Treatment Stitches, also called sutures, are special types of thread that hold wound edges together while they heal. Stitches help to stop bleeding, reduce scarring, and decrease the chance of infection in the wound. Steri-Strips® are special adhesive bandages that can sometimes be used on shallow wounds instead of stitches. Steri-Strips® perform the same functions as stitches. Lacerations that involve the face, are longer than 1/2 inch, are deep, or are bleeding heavily, may require stitches. (see incision wound care for explanations, including liquid glue)

Avulsion Layers of skin torn off completely or only flap of skin remains Same mechanism as laceration, but to extent that tissue is completely ripped from it’s source May be considerable bleeding

Avulsion—Treatment Control bleeding using pressure Clean wound with soap and water If flap of skin remains connected replace skin in its original position If deep avulsion, seek medical attention for stitches if skin flap is dirty, remove Many times skin in affected area will survive

Puncture Wound Penetration of skin by sharp object Nails, tacks, knives, teeth, spikes, cleats May be small in diameter and not seem serious Can become infected easily b/c dirt and germs carried deep in the tissue

Puncture wound treatment Find out if part of object that caused wound still in the wound i.e. lead from a pencil Determine if other tissues have been injured by the object Blood vessels, nerves, tendons, ligaments, bones, internal organs Prevent infections Bacterial skin infections, tetanus, infections in deeper structures (bones and joints) Wounds at risk of infection bc they are difficult to clean and provide a warm, moist place for bacteria to grow

Contusion A blow compresses or crushes the skin surface and produces bleeding under the skin Does not break skin Bruising due to injury to blood vessels Most mild and respond well to RICE

Contusion—Signs & Symptoms Bruising (Ecchymosis) swelling (Edema) Pain to touch Redness Bluegreenpurplebrownish/yellowish

Contusion—Treatment Careful monitoring Anti-inflammatory oral medications Rest Ice Compressive dressing Elevation (above heart) Most are mild and respond to RICE; more serious need to be checked by physician Immediately apply ice in stretched position (keeps muscle from tightening up in response to injury) Athlete may return to full participation when he/she has FROM, full strength, able to complete fully; padding to prevent athlete being struck again

Blister Continuous rubbing over the surface of the skin causes a collection of fluid below or within the epidermal layer

Blister—Treatment Keep closed (do not pop) and keep covered. If blister pops…keep clean to prevent infection If fluid white/yellow need medical attention (infection)