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I A. Closed wounds
Contusion: Can be minor soft tissue injury without break in the skin, or major such as when being run over by a vehicle. Generally, it produces discolouration of the skin due to collection of blood underneath.
Abrasion: In this wound, epide1mis of the skin is scraped away exposing the dermis. They are painful as dermal nerve endings are exposed. These wounds need cleaning, antibiotics and proper dressings.
Haematoma: This refers to collection of blood usually following injury. It can occur spontaneously in patients who have bleeding tendencies such as haemophilia. Depending upon the site, it can be subcutaneous, intramuscular or even subperiosteal. A knee joint haematoma may need to be aspirated followed by application of compression bandage. Small haematomas get absorbed. If not, they can get infected.
B. Open wounds
Incised wounds: They are caused by sharp objects such as knife, blade, glass, etc. This type of wound has a sharp edge and is less contaminated. Primary suturing is ideal for such wounds, as it gives a neat and clean scar.
Lacerated wounds: They are caused by blunt injury such as fall on a stone or due to road traffic accidents (RTA). Edges are jagged. The injury may involve only skin and subcutaneous tissue or sometimes deeper structures also. Due to the blunt nature of the object, there is crushing of the tissue which may result in haematoma, bruising or even necrosis of the tissue. These wounds are treated by wound excision and primary suturing provided they are treated within six hours of injury.
Penetrating wounds: They are not uncommon. Stab injuries of abdomen are very notorious. It may look like an innocent injury with a small, 1 or 2 cm long cut but internal organs such as intestines, liver, spleen or mesenteric blood vessels may have been damaged. All penetrating wounds of the abdomen should be admitted and observed for at least 24 hours. Layer by layer exploration and repair, though recommended, may not be possible at times due to oblique track of the wound.