Examples: knife wound, incision with surgical instrument. This type of wound will heal after the edges are brought together by :
- an adhesive suture (strips) for superficial wounds
- a surgical suture for deeper wounds.
Healing will be fast (5 to 15 days depending on the skin thickness). The result will be aesthetic, functional and satisfactory with a linear scar.
There is a partial separation as far as the dermal-epidermal junction.
The tops of the papillae disappear but there are still some islands within the epidermis of basal and germinative cells which will result in spontaneous healing.
Intact basal cells will multiply and healing will take place from the deeper layers upwards towards the surface layers.
An initial pinkish and fragile neo-epidermis will be formed in 10 to 12 days.
This will be referred to as first-line healing,( healing by primary intension) in other words, spontaneous healing which will not result in any scar or slight change to the skin appearance.
Loss of tissue is the consequence of a serious trauma and affects the entire thickness of the skin, with a complete interruption of the dermal-epidermal junction.
If the loss of tissue is extensive, it is impossible to bring the edges of the wound together by suturing.
Second-line healing of the wound should occur; this will be referred to as directed healing. (Healing by secondary intension)
Acute wounds
A traumatic wound is a contused wound characterised by:
- Torn and irregular edges
- The presence of devitalised tissue fragments
- The presence of foreign matter (gravel, etc.)
Cut wounds
These wounds are caused by a sharp object.
Penetrating wounds
These wounds are caused by firearms / knives. It is difficult to evaluate their depth and severity.
Burns are damage to the skin, and sometimes to underlying tissues, caused by contact of the skin with a hot substance.
Epidemiology of burns:
- 400,000 to 500,000 burn victims go to hospital for treatment
- 15,000 to 20,000 are hospitalised, 3000 in specialised burns centres
- 22 specialised burns centres
- 1000 immediate deaths.
Most burns (95%) are of thermal origin but can also be electrical and chemical.
The prognosis in terms of life or death depends on the extent of the burn.
The prognosis in terms of function depends on the depth and the location.
A distinction is made between 4 depths:
- A first-degree burn refers to a burn that affects the superficial layers of the epidermis with no basal lesions. It is recognised by the lack of any separation (no phlyctena or blisters) and the presence of painful erythema. Spontaneous healing occurs within 2 to 3 days with no residual effects.
- A superficial second-degree burn is a lesion affecting almost all of the epidermis, including part of the basement membrane and Malpighi cells. Morphologically, it is recognised by the continuous presence of blisters, the base of which are red following excision , well vascularised and very sensitive. Spontaneous healing normally occurs within 1 to 2 weeks with no residual effects, but there is still some risk of an indelible scar, particularly in children, non-caucasian skin and more generally when healing is delayed by a complication (usually local infection).
- A deep second-degree burn consists of complete destruction of the epidermis and the superficial dermis. All that remains intact is the deep dermis and skin appendages (hair, sweat and sebaceous glands). These burns, like superficial second-degree burns, have blisters, but following excision, the base of the blisters look whitish-pink, are poorly vascularised and have reduced sensitivity. . Spontaneous healing is possible but slow (2 to 4 weeks). T he general condition of the patient or a local secondary infection can frequently deepen the lesions by destroying the few surviving epidermal cells preventing normal spontaneous healing.
- A third-degree burn consists of complete destruction of the skin with a minimum inclusion of , the entire epidermis and the dermis. It looks like an adherent cutaneous necrosis, without phlyctena, of more or less dark colour (from white to brown to black), with total loss of sensitivity. The complete disappearance of epiderm al cells does not allow spontaneous healing and definitive cutaneous healing can only be obtained by autograft, ie: by the import of autologous epiderm al tissues, taken from an area of intact skin. Skin-grafting is only possible following excision of the cutaneous necrosis.
A surgical wound is a skin incision, made with the objective of eliminating a skin lesion or creating a path for reaching deep organs.
The term skin abrasion defines itself. Lesions are due to scraping of the surface layer of the skin, leaving the basement membrane intact and therefore keeping maintaining the capacity to heal by itself in more than 50% of cases. When the dermis is affected over most of the lesion, it will result in a scar. will remain. Complete epithelialisation of the lesion, usually achieved within three weeks, may take longer if a larger area of the dermis is affected.
