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 exit  wounds. 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 infected. 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 4-21