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 infected 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.
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.
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 instruments 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 laceration. 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 objects 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 infection 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 usually 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 immerse it in water or saline. The limb can often be successfully reattached.
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