Contused wound (Vulnus consutum)

A blunt object causes these wounds. Before the damaging of skin, the blunt object has to injure the soft deep tissues or organs (muscles, bones). Around the wound appears the wide zone of damage saturated with blood and destroying life activity (necrosis). Contused wound causes pain syndrome (big and injured zone), but the external bleeding is small (vessel's wall is damaged spreading a large area being thrombosed fast), but there can be hemor­rhages. According to these complications contused wound heals by secondary tension.

Lacerated wound

A blunt object causes these wounds but this object is directed under the acute angle to the skin. We can observe a big separation and sometimes to scalp of the skin. Accord­ing to this separation skin can necrotize. Sometimes this kind of wounds can be caused by fractured parts of bones.

5. Crushed wound

6. The mechanism of this damage is equal to the vulnus consutum and vulnus laceratum, but the degree of injury is maximal. These wounds seldom can lead to the incision of the skin, because the injured zone is very large. Crushed wound heals worse, and there can be infections.

Slash wound

Slash wound caused by big and sharp object, that's why these wounds take the medium place between cut (incised) wound and contused wound. During this kind of wound the internal organs and bones are damaged very often. Such a wound may lead to spreading necrosis. Pain syndrome is very strong. Bleeding not severe, but massive diapedesis hemorrhages are present.

Bite wound

The special features of this wound are bite by animals or man. Bite wound is more infected than other wounds. This wound may be complicated by acute infection, but the zone of damage is small. Some toxins may intoxicate the saliva (snake bite). Besides that, the bite wound may be contamination by tetanus.

Mixed wound

These wounds may connect two and more kinds of wounds.

  9.     Gunshot wound

a) This wound has three zones of damaging.

For all kinds of wounds is characteristic the presence of 2 zones of damage: wound canal and traumatic necrosis. The obser­vation of gunshot wounds determined that they differ by a long period of healing.The main difference of gunshot wound is high speed of object (bullet, splinter).Common knowledge is that the energy of free moving object is equal mV²/2. Ac­cording to this the damage of the tissues is very strong. A sharp bullet more easilygoes through the tissues but if the bullet looses stability, it starts to "rummage". Insuch case the bullet returns its energy to the tissues. During the penetration of thebullet into the tissues the area of increased pressure is formed which has the com­pressed tissues. This compression expands from the bullet. This is the phenomenonof "side stroke". According to this a temporary cavity is formed. This cavity may bepulsatile and the tissues with great speed contact relax, mutually displace. The pres­sure in the inner part of the cavity is 1000 atm, and the load on the wall of a vessel is120 kg/sm². Such mechanism causes 3 zones of damage.

The zones of damage:

1. wound canal. In some cases there can be a bullet, or parts of necrotic tissue, blood and bacterias.

2. direct traumatic necrosis. Appears during the influence of kinetic energy. It consists of viable or unviable tissues, which are saturated with blood.

3. the zone of molecular contusion. It consists of tissues, which have malfunction of metabolism and of cellular structures. During the uncomfortable conditions, for ex­ample, the decreasing of perfusion, oxygenation, developing of the infection, the tis­sues devitalize (die). This zone is called "a stockpile of the following necrosis". This zone causes problems with treatment.

b)    Complex anatomical character of damage

High kinetic energy causes not only presence of three zones, but also their complex anatomical character. What does it mean?

During the damage very often injure of some cavities of the organism is observed. Sometimes we can meet splinter fractures of the bones, and during injure of inner or­gans we can observe their rupture. Not always the wound canal is the direct line from the entrance to the exit aperture. It may look as indmeet line and may cause the damage of different organs.

c) High level of infection

Gunshot wound is very often complicated by the development of infection. High level of infection with the necrotic mass increases the risk of suppuration. And accord­ing to big damage of the muscle and small diameter of the entrance aperture, the access for the oxygen is very difficult, and this is the big evidence for the development of anaerobic infection.

d) Additional classification.

According to the character of wound canal:

1. A thorough damage - it has entrance and exit apertures (a bullet is out of the organism).

2. Blind injury - in has only entrance aperture (bullet is at the end of wound canal).

3. Tangential - the damage of superficial tissues, without the penetration to the cavities of the organism.

According to the factor of damage:

1. Small speed damage gunshot. The speed of the bullet is 600 m/s. The wound canal more often may be direct and blind. Such wound has, as a rule, a small entrance aperture and not big tissue damage.

2. High-speed damage. The speed of the bullet is 900 m/s and more. These wounds have small entrance aperture and wide, with defect of tissues, exit aperture. Wound canal winding, that's why we may observe the injury of many organs and tissues. More destroying effect may be caused by explosive shells.

3. Shot wounds. These wounds have many separate apertures, bleeding, the contusion of organs and tissues.

According to the zone of damage:

1. Wounds with a small zone of damage. These wounds have a small border of the incision and the necrotic zone is very small. The wounds with small zone have no complications, small hiatus.

2. The wounds with a large zone of damage. These wounds have insignificant hemorrhage, strong pain, long healing, and many complications.

       Classification according to the level of infection

1. Aseptic.

2. Fresh infected.

3. Suppurative.

1.      Aseptic wounds

This wound is caused in the operative room with norms of aseptic. Such wound heals soon, and they do not have any complications.

But the operative wounds may be different: for example the operation of the ves­sels - infection is minimal and appendicitis a high level of infection.

According to the level of microbial contamination all operation are divided into four kinds:

• Aseptic operation (planned primary operation without the opening of cavity of inner organs).

• Conditionally aseptic - there may be infection in some cases.

• Operation with big danger of infection - conditionally infected.

• Very high level of infection - infective operations (purulent processes).

Fresh-infected wounds

4. This is the wound, which was made outside of the operation or during 3 days from

the moment of damage. The level of infection in this wound is different and it depends on the kind of an object, conditions of damage. Fresh-infected wound have quantity of microorganisms not more than 10⁵ per lg of tissue.

Suppurative wounds

They are infected too. But they differ from fresh infected with the presence of infective process. This infection causes inflammatory reaction, necrosis, formation the suppuration, and general intoxication.