Classification of wounds, principles of wound care
1. Big picture
A wound is a disruption of tissue continuity, usually involving the skin and possibly deeper structures such as fascia, muscle, vessels, nerves, tendons, bone, or body cavities. In surgery, the examiner wants you to answer three questions:
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What type of wound is it? Clean, contaminated, dirty, bite, crush, puncture, surgical incision, chronic ulcer, burn, open fracture, penetrating cavity injury.
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Can it be closed now? Primary closure, delayed primary closure, secondary intention, graft/flap, or negative-pressure wound therapy.
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What complications must not be missed? Bleeding, foreign body, tendon/nerve/vessel injury, open fracture, infection, necrotizing fasciitis, tetanus, gas gangrene, compartment syndrome, dehiscence.
The core surgical principle is:
Assess → control bleeding → clean/irrigate → debride → prevent infection/tetanus → choose closure method → dress and follow up.
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