Traumatic open wounds: Let’s define the types

A girl has a Bandaid on her knee covering an open wound.

Learn the difference between the types of open wounds caused by trauma.

Open wound types include abrasions, excoriation, skin tears, avulsions, lacerations and punctures, according to our Skin and Wound Management course workbook.

Traumatic open wounds involve a disruption in the integrity of the skin and underlying tissues caused by mechanical forces. In other words, these wounds are caused by brief but forceful contact with another object or surface.

Differentiating the types of traumatic open wounds involves noting the shape and depth, as well as the nature of the mechanical force that caused it.

Below, we outline six acute, traumatic open wounds that are commonly confused.

Abrasion

Abrasions result from shearing of the skin by a rough surface. They appear as lines of scraped skin with tiny spots of bleeding.

Their size can vary from the common scraped knee to road rash over a large area of the body.

Abrasions are always partial thickness, however. You’ll see skin loss through the epidermis and sometimes into the dermis, but not through the entire dermis.

Excoriation

In a layperson’s terms, excoriation is called a scratch. It is similar to abrasion in that it is a partial thickness shearing of skin.

With excoriation, however, the erosion is even more noticeably linear (line-like) because of the mechanical force that caused it.

Light contact with cat’s claws, for example, leads to excoriation, whereas brushing or dragging the skin across a rough, flat surface such as pavement leads to abrasion.

Many clinicians mistakenly use the term excoriation to refer to denudation, which is the correct term for the loss of the epidermis that’s caused by prolonged exposure to body fluids such as urine, feces and exudate plus friction.

When assessing a case of Moisture Associated Skin Dermatitis (MASD), document the areas of erosion as denuded, not excoriated.

Skin tear

The International Skin Tear Advisory Panel (ISTAP) defines skin tears as follows:

A skin tear is a wound caused by shear, friction and/or blunt force resulting in separation of skin layers. A skin tear can be partial thickness (separation of the epidermis from the dermis) or full thickness (separation of both the epidermis and dermis from underlying structures).

Skin tears occur principally on the extremities of older adults because of changes in the skin’s structure that make it more fragile, such as flattening of the junction between the dermis and epidermis. Infants are more vulnerable to skin tears as well.

The ISTAP has developed a skin tear classification system:

  • Type 1: No skin loss. Linear or flap tear that can be repositioned to cover the wound bed.
  • Type 2: Partial skin loss. Partial flap loss that cannot be repositioned to cover the wound bed.
  • Type 3: Total flap loss. Total flap loss exposing entire wound bed.

Because there are a reported 1.5 million instances of skin tears among patients within hospitals, long-term care facilities and other settings, there are global efforts to promote skin tear prevention within these institutions.

Efforts include recommending environmental modifications and raising awareness of the proper care for aging and immature skin.

Avulsion

A skin avulsion, also called “degloving,” occurs when tissue is not just separated but forcefully torn away from the body. It is marked by heavy, rapid bleeding and a noticeable absence of tissue.

Avulsions go deep into the subcutaneous tissue or further (muscle or bone).

The key difference between skin tears and avulsions is depth, which is directly related to the level of force applied.

WCEI Clinical Instructor Bill Richlen, PT, WCC, DWC, explains, “Skin tears can be both full or partial thickness. However, in the case of a skin tear, the full thickness ones are generally only deep enough to expose the subcutaneous tissue.”

Laceration

Lacerations are torn or jagged wounds with edges that do not readily line up. Tear lacerations tend to be caused by blunt force trauma, such as a blow, fall or collision.

A blunt injury that rips open the skin over a bony prominence, such as the scalp, is one example. There may be little or profuse bleeding and minimal or extensive tissue damage.

Puncture

Puncture wounds are caused by a sharp object that deeply penetrates the skin, such as a nail. Generally, puncture wounds are deeper than they are wide.

Typically, there’s little bleeding around the outside of the wound and more bleeding inside, causing discoloration.

Open wounds can mix and mingle

Note that multiple open wound types can result from a single source of trauma.

A bite from a large dog can cause a crush injury, which may lead to lacerations, puncture wounds and avulsion.

By using the correct terms for open wounds, you can communicate clearly and efficiently with your team, giving them an accurate understanding of the wound being treated.

Discuss chronic and acute wound types in our five-day Skin and Wound Management Course.


Keisha Smith, MA, CWCMS, is a freelance digital marketing consultant who works with clients in healthcare, law and behavioral health. Her specialties include content creation, social media and brand clarity. As an eight-time Wild On Wounds conference staff member and an alumna of WCEI’s training program for wound care marketing professionals, she loves the exceptional passion of clinicians who treat wounds. She frequently finds herself advising friends and family to keep their minor wounds warm and moist.

Wound Care Education Institute Skin and Wound Management course workbook.

What do you think?

comments

Leave a Reply

You must be logged in to post a comment.