1. Skin Wounds Classification

2. 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

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

4. 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

5. 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

6. 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

7. Laceration(shallow)

8. Laceration(deep)

9. 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)

10. 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.

11. 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)

12. 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

13. 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

14. 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

15. 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

16. 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

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

18. 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

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

20. 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)