Research

A few research about wounds.

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The skin is a large sensory organ that interacts with the environment, and sends signals to the brain about touch, pain, vibration, and position.

There are two layers of skin that cover the body, the epidermis and dermis.

The epidermis is the outermost layer of skin, the part that can be seen, and is very active with new skin cells being formed and gradually being shed. There are different kinds of epidermal cells:

Keratinocytes are the main skin cells that we see. New epidermal cells begin where the epidermis and dermis meet. These cells gradually mature and rise to the surface of the skin and are eventually shed to be replaced by new ones. The epidermis has no blood vessels and receives nutrition from the underlying dermis.

Melanocytes contain pigment and provide coloration to the skin and are responsible for absorbing radiation and protecting against the damage caused by ultraviolet radiation.

Langerhan cells are made in the bone marrow and migrate to the surface of the skin and help fight infection.

Merkel cells are specialized skin cells that help with sensing light touch. They are located on the tips of fingers and toes as well as other specialized areas.

The dermis is the deeper layer of skin. It has two layers that are responsible for supporting the epidermis:

The papillary dermis is a thin layer of tissue located just beneath the epidermis and contains capillary blood vessels and a few elastic and collagen fibers.

The deeper reticular dermis contains large bundles of collagen and elastic fibers that run parallel to the skin surface. The collagen and elastic fibers are responsible for helping the skin resist injury from shearing or other types of trauma, and allow the skin to return to its resting state after being stretched or compressed. This is the layer where hair follicles, sweat glands and sebaceous glands are found.

Subcutaneous fat tissue underlies the layers of epidermis and dermis and provides extra cushioning for the skin. Beneath this layer lie muscle and bone.

Wound Causes and Types

Wounds occur when the skin is broken or damaged because of injury. The skin can be damaged in a variety of ways depending upon the mechanism of injury.

Inflammation is the skin's initial response to injury.

Superficial (on the surface) wounds and abrasions leave the deeper skin layers in tact. These types of wounds are usually caused by friction rubbing against an abrasive surface.

Deep abrasions (cuts or lacerations) go through all the layers of the skin and into underlying tissue like muscle or bone.

Puncture wounds are usually caused by a sharp pointed object entering the skin. Examples of puncture wounds include a needle stick, stepping on a nail, or a stab wound with a knife.

Human and animal bites can be classified as puncture wounds, abrasions, or a combination of both.

Pressure sores (bed sores) can develop due to lack of blood supply to the skin caused by chronic pressure on an area of the skin (for example, a person who is bedridden, sits for long hours in a wheelchair, or a cast pressing on the skin). Individuals with diabetes, poor circulation (peripheral vascular disease), or malnutrition are at an increased risk of pressure sores.

Proper wound care is necessary to prevent infection, assure there are no other associated injuries, and to promote healing of the skin. An additional goal, if possible, is to have a good cosmetic result after the wound has completely healed.

This wound care article is designed to present information on wounds involving mainly the skin; it is not meant to cover all wounds (for example, gunshot, degloving wounds, tendon lacerations, and others).

Wound Self-Care at Home

·         Most wounds may be cared for at home. Superficial abrasions and lacerations can be cleaned, an antibacterial ointment applied, and then covered with a band-aid or light bandage.

·         Bleeding can often be controlled with direct pressure to the wound, and if possible, elevating the bleeding site above the level of the heart. This allows gravity to help decrease blood flow to the injury. Most bleeding will stop within 10 minutes, at which point, a dressing can be placed over the wound.

·         If bleeding is not an problem, the wound can be cleaned using tap water to wash out any debris to decrease the risk of infection. River and lake water can contain many types of bacteria that can cause significant infection. It is not recommended to clean wounds with contaminated water.

·         Deeper wounds are painful and scrubbing is not necessarily advised.

·         If a wound needs medical care, there are steps that can be taken at home to begin treatment. Unless there is a significant underlying injury, there is ample time to seek medical care and it is appropriate to take a few minutes to clean and dress the wound.

When to Seek Medical Care for a Wound

Most wounds can be treated at home with routine first aid including thorough washing and dressing to prevent infection.

Some of the following are reasons medical care should be obtained for a wound:

·         If the wound is due to significant force or trauma and other injures are be present.

·         If bleeding cannot be stopped even with persistent pressure and elevation.

·         If there is concern that wound requires repair with sutures (stitches). The size and location of the wound are important considerations. Most facial wounds may need to be repaired for cosmetic reasons, especially if they involve the lip or eye.

·         If the wound is caused by an animal bite. At least 50% of dog bites, 80% of cat bites, and 100% of human bites become infected. There is also a need to consider rabies immunizations if appropriate.

·         If the wound is very dirty and cannot be easily cleaned.

·         If there is evidence of infection including redness, swelling, increased pain, and pus at the wound.

·         If tetanus immunizations are not up to date, then a booster is needed within 48 hours. If the patient has never been immunized, the initial tetanus prevention with immunoglobulin should be given immediately.