Size of the Wound
In general, since large wounds are more
serious than small ones, they usually involve more
severe bleeding, more damage to the underlying
organs or tissues, and a greater degree of shock.
However, small wounds are sometimes more
dangerous than large ones; they may become in-
fected more readily due to neglect. The depth of
the wound is also important because it may lead
to a complete perforation of an organ or the body,
with the additional complication of entrance and
Location of the Wound
Since a wound may involve serious damage to
the deeper structures, as well as to the skin and
the tissue immediately below it, the location of
the wound is important. For example, a knife
wound to the chest may puncture a lung and cause
interference with breathing. The same type of
wound in the abdomen may result in a dangerous
infection in the abdominal cavity, or it might
puncture the intestines, liver, kidneys, or other
vital organs. A knife wound to the head may cause
brain damage, but the same wound in a less vital
spot such as an arm or leg might be less important.
Types of Wounds
When you consider the manner in which the
skin or tissue is broken, there are six general kinds
of wounds: abrasions, incisions, lacerations,
punctures, avulsions, and amputations. Many
wounds, of course, are combinations of two or
more of these basic types.
ABRASIONS. Abrasions are made when the
skin is rubbed or scraped off. Rope burns, floor
burns, and skinned knees or elbows are common
examples of abrasions. This kind of wound can
become infected quite easily because dirt and
germs are usually embedded in the tissues.
INCISIONS. Incisions, commonly called
CUTS, are wounds made by sharp cutting in-
struments such as knives, razors, and broken
glass. Incisions tend to bleed freely because the
blood vessels are cut cleanly and without ragged
edges. There is little damage to the surrounding
tissues. Of all classes of wounds, incisions are the
least likely to become infected, since the free flow
of blood washes out many of the microorganisms
(germs) that cause infection.
LACERATIONS. These wounds are torn,
rather than cut. They have ragged, irregular edges
and masses of torn tissue underneath. These
wounds are usually made by blunt, rather than
sharp, objects. A wound made by a dull knife,
for instance, is more likely to be a laceration than
an incision. Bomb fragments often cause lacera-
tion. Many of the wounds caused by accidents
with machinery are lacerations; they are often
complicated by crushing of the tissues as well.
Lacerations are frequently contaminated with dirt,
grease, or other material that is ground into the
tissue; they are therefore very likely to become
PUNCTURES. Punctures are caused by ob-
jects that penetrate into the tissues while leaving
a small surface opening. Wounds made by nails,
needles, wire, and bullets are usually punctures.
As a rule, small puncture wounds do not bleed
freely; however, large puncture wounds may cause
severe internal bleeding. The possibility of infec-
tion is great in all puncture wounds, especially if
the penetrating object has tetanus bacteria on it.
To prevent anaerobic infections, primary closures
are not made in the case of puncture wounds.
AVULSIONS. An avulsion is the tearing
away of tissue from a body part. Bleeding is usu-
ally heavy. In certain situations, the torn tissue
may be surgically reattached. It can be saved for
medical evaluation by wrapping it in a sterile
dressing and placing it in a cool container, and
rushing it, along with the victim, to a medical
facility. Do not allow the avulsed portion to freeze
and do not immerse it in water or saline.
AMPUTATIONS. A traumatic amputation
is the nonsurgical removal of the limb from the
body. Bleeding is heavy and requires a tourniquet,
which will be discussed later, to stop the flow.
Shock is certain to develop in these cases. As with
avulsed tissue, wrap the limb in sterile dressings,
place it in a cool container, and transport it to
the hospital with the victim. Do not allow the limb
to be in direct contact with ice, and do not im-
merse it in water or saline. The limb can often
be successfully reattached.
Causes of the Wound
Although it is not always necessary to know
what agent or object has caused the wound, it is
helpful. Knowing what has caused the wound may
give you some idea of the probable size of the