Classification of Wounds

Classification of wounds can be done in many ways.

Classification of Wounds Based on the Thickness of the wound

Superficial Wounds

These involve only the epidermis and the dermis up to the dermal papillae.

Partial-thickness Wounds

Partial thickness wounds involve skin loss up to the lower dermis.

Full-thickness Wounds

Full thickness wounds involve the skin and the subcutaneous tissue.

Deep Wounds

Deep wounds include complicated wounds with laceration of blood vessels and nerves, wounds penetrating into natural cavities, and wounds penetrating into an organ or tissue

Classification of Wounds Based on Involvement Structures

These are of two types

–  Simple which comprise only one organ or tissue.
– Combined wounds which involve two or more tissues.

Classification of wounds Based on Time Elapsed

– Fresh wounds, up to 8 hours from the trauma
Old wounds, after 8 hours from trauma or skin discontinuity

Classification of wounds Based on Morphology

• Excoriation or scarification [It is the most superficial type]
• Incised wound [As in surgical incision]
• Crush wound [Generally occurs with a heavy blow]
• Contused wound
• Lacerated wound [Fragments of tissue are torn as result of sharp injury]
• Slicing wound [ As in detachment of epicranial epineurosis.]
• Stab wound [Made with a pointed tool or a weapon]
• Gunshot Wound
• Animal/human bite

Classification of wounds Based on How the Wound Heals

Primary Healing

This type of healing occurs when the wound edges are brought together/ approximated. There is minimal scarring in this case.

Most surgical wounds heal by primary intention healing.

Delayed Primary Healing

This type of wound healing occurs when a wound is initially cleaned, debrided, and observed, typically 4 or 5 days before closure. Many wounds which are initially contaminated are purposely left open and a delayed closure is done.

Healing By Secondary Intention

In this type of healing, a full-thickness wound is allowed to close and heal. Secondary healing results in an inflammatory response that is more intense than with primary wound healing. A larger amount of granulation tissue is formed and there is a greater contraction. This kind of healing leads to larger scars.

Healing by Epithelization

Epithelization is a part of wound healing occurs in all kinds of wound healing as part of the phases of wound healing. It is the process by which epithelial cells migrate and replicate and traverse the wound.

In wounds involving only the epidermis and superficial dermis, epithelization is the predominant method by which healing occurs.

Classification of Wound by Bacterial Contamination

Clean

Wounds are usually made by the doctor during a surgery under sterile conditions. Only normally present skin bacteria are detectable.

Clean Contaminated Wounds

This is a clean wound which got contaminated. The contamination of clean wounds is endogenous and comes from the environment, the surgical team, or the patient’s skin surrounding the wound.

Contaminated Non-Purulent Inflammation

Wounds contaminated by gross spillage from gastrointestinal tract or entry into biliary or genitourinary tract in the presence of infected bile or urine. A  major break or in aseptic technique during surgery comes in this category. A  penetrating trauma <4 hours old or chronic open wounds which are grafted or covered are considered contaminated.

Dirty Purulent Inflammation

Abscess, preoperative perforation of the  respiratory,  gastrointestinal, biliary or genitourinary tract or penetrating trauma >4 hours old.