A wound is a break in the skin or between the skin and the tissues beneath it. A wound usually arises as a result of a mechanical trauma, but a trauma, i.e. a wound, can also be, for example, a burn. Injuries can be mechanical, thermal, or chemical. Depending on the mechanism of the wound formation, we distinguish bruised, lacerated, cut, and bitten wounds.

Types of wounds

Due to their causes and specific features, wounds are divided into several types.

• Abrasionsare wounds that occur when an injury acts tangentially to the surface of the skin; in children, if they slip, they may rub the skin, e.g. on the knee. Often the wound is contaminated (e.g. with earth), may bleed moderately, but is painful due to damage to the nerve endings.
• A cut woundis the result of an injury with a sharp object (glass, knife). The depth of the wound depends on the pressure on the wound, and the wound usually bleeds heavily.
• A flap woundis formed when the wound is positioned obliquely, tangent to the skin surface – then a detached fragment of skin appears that may hang loose.
• A chopped woundis the result of trauma to a heavy and sharp object (cleaver, ax, saber) and may even lead to a partial or full amputation of a part of the body (e.g. a finger).
• Stab woundsare caused by the action of a sharp object (sword, dagger, bayonet, nail). The opening of the wound can be small, but the damage inside can be deep and unpredictable.
• Mashed woundsare caused by a blunt-edged object. The edges of the wound are squashed and uneven, and bleeding may occur around the wound.
• Crush woundsoccur after the action of a blunt tool with great force, and adjacent tissues may also be damaged.
• Lacerationsare the result of curved objects tearing the skin (e.g. hooking, knots).
• Gunshot woundsare caused by being shot by a firearm, a bomb or a mine. The entrance wound may be minor, but significant internal damage.
• Bitten woundsare the result of a bite, they are infected with bacteria in the saliva and therefore often difficult to heal.

The wound causes pain, bleeding and the risk of infection of the wound as a result of the factor causing the injury. The pain of the wound itself and its vicinity, and its severity, largely depend on the extent of the wound, its depth and its innervation. Bleeding occurs to varying degrees in any wound, and is caused by damage to small, and sometimes larger, blood vessels.

Infection can develop in a wound that has been contaminated with bacteria either on the skin or from the environment, when the wound comes into contact with, for example, dirty surfaces or soil.

Wound healing

Wound healing begins shortly after its inception. At first, the blood vessels around the wound contract and platelets build up, stopping the outflow of blood. In turn, the so-called process of fibrinogenesis. A gelatinous plug is formed which acts as an adhesive to hold the edges of the wound together. The wound shows fibroblasts and macrophages that cleanse the wound of bacteria and dead tissue. It is an inflammatory process that always accompanies injuries and is the body’s defensive response.

When the inflammatory process begins to subside, macrophages appear in the wound, which further cleanse the wound of dead cells and release the so-called growth factors needed for proper wound healing. Then, fibroblasts appear in the wound, initiating the healing of the wound. At the same time, the blood vessels growing into the wound are stimulated and multiplied. A wound healing element is also covering it with epithelium, growing from the edges.

About 3 weeks after the injury, the wound should be properly healed and form a scar that will remodel spontaneously for a long time.

The proper wound healing described above is called primary healing, i.e. by rapid growth.

Healing processes can be disrupted, for example, as a result of extensive necrosis of the wound or its edges, or the development of inflammation. This causes healing disorders and a prolongation of normal repair processes. Then, at the bottom of the wound, a granulation tissue is formed, into which blood vessels grow. Granulation becomes the substrate of the remodeling processes, and healing progresses from the edges of the wound. This method of healing is called secondary or granulation.

Various factors influence the speed of wound healing, including: location of the wound, blood supply to the wound area, sterility or contamination of the wound, wounding factor, time from wound and method of wound care, accompanying diseases.

There may also be more problems with wound healing that require different solutions. In the event of wound healing complications, various healing and anti-inflammatory agents are used. Sometimes additional surgical treatment may also be indicated, from the simplest one, consisting in cleaning the wound, cutting its edges and bringing them together with surgical sutures, to skin grafts and plastic procedures.

Principles of initial treatment of wounds and fractures at the accident site

When giving first aid in case of injuries, the wound should be properly treated.

In the case of minor cuts and wounds, they can be rinsed with running water. Even larger wounds are recommended to be rinsed with plain running water from the tap. If we have a disinfectant, it is advisable to use them in case of larger and contaminated wounds. If there are larger debris in the wound, it should be removed.

After removing impurities and rinsing the wound, or decontaminating it, apply a dressing. The best gauze or gauze bandage – made of cotton, and now also of plastics.

If there is more bleeding, an additional dressing material may be applied to the gauze, in the form of lignin or gauze, which will absorb blood in addition to compressing it. The dressing prepared in this way can be fixed with adhesive tape, and if the dressing is larger – with a woven bandage or an elastic band.

In the event of heavy bleeding from the wound, a pressure dressing is placed over the bleeding site. It consists in applying a thicker layer of the dressing – first gauze, then next layers of gauze or lignin, bandaged over a slightly larger space. In situations of sudden hemorrhage, we do not remove any foreign bodies from the wound, but cover it with a sterile dressing and transport the patient to the hospital emergency department (HED) as soon as possible. The dressing must adhere well to the wound, so it is better to fix it – and also give it more pressure – with a woven cotton or elastic band. We bandage in one direction, over a greater distance, because this way we will fix the dressing better. If the dressing is soaked with blood, do not remove it, but put another dressing on top and bandage it.

In an emergency, you can also use a triangular scarf as a last resort, which is often also available in the basic equipment of the first aid kit. Then, for example, the limb can be attached to the chest. Fixing the damaged area, e.g. a limb, reduces bleeding and the risk of additional injuries.