What is an open wound?
What is an open wound?
An open wound is a break in the skin. The open wound can vary in depth and range from a minor injury to a severe injury that exposes underlying structures. All open wounds are a break in the protective surface of the skin which can increase the risk of infection and complications in healing if not properly cared for. Superficial open wounds are typically treated at home and deeper wounds may require medical management.
What types of open wounds occur is related to the type of injury. Abrasions are scrapes to the skin often as a result of a fall or other minor accident. Lacerations are cuts that can be superficial, like a paper cut, or deep injuries with sharp things like knives, machinery, or tools. They are often caused by an accident or trauma injury. Puncture wounds occur when a sharp object pierces the skin, which often leads to small surface open areas with deeper damage. Open wounds can also be caused by surgical incisions that open or pressure injuries caused by friction, shear, and pressure on bony prominences. Open wounds can be related to health issues like diabetes, poor circulation, and lymphedema, making individuals prone to skin damage. Comorbid conditions will need addressing to maximize the ability to heal quickly.
When you have an open wound it is important to take immediate action to prevent infection and encourage healing. The first step is to clean the wound thoroughly and remove any visible debris. Using soap and water is acceptable on initial injury, however, a pH-balanced wound cleanser is ideal. If there are signs of infection like pus, redness, and pain, then an antimicrobial or antiseptic cleanser may be warranted. Bleeding after initial injury is another factor to monitor. Bleeding should stop fairly quickly, especially if the wound is superficial and overpressure is applied. A wound that will not stop bleeding is a reason to seek emergency medical care.
When bleeding will not stop, it is likely an indication that the damage has been done to deeper tissues. The epidermis is the most superficial layer of skin and contains three types of cells; squamous, basal and melanocytes. Blood supply comes from vessels that are located in the deeper layer of the dermis. Below the dermis lies the subcutaneous fat, muscles, tendons and bones, as well as the more robust circulatory systems like arteries and veins that will bleed more aggressively when damaged. Injuries that are superficial and only involve the epidermis will bleed a lot less and heal much faster. Wounds that penetrate deeper to the dermis and down to the underlying structures will have a greater chance of infection, necrotic tissue and complicated healing.
How an open wound heals depends on how deep the damage is. A superficial open wound should heal quickly if kept clean, dry and covered. Epithelial tissue will replace itself unlike dermal tissue which fills in with a scar. Research has shown that wounds heal faster when a moist wound healing environment is maintained. Moist wound healing can be mostly achieved with quality dressings versus using open weave gauze, which allows a wound to dry out. Dry gauze also sticks to the wound, pulls off new cell growth, often causing pain on removal and providing a poor barrier to bacteria. A deeper wound may require the open space be filled with a primary dressing in direct contact with the wound bed. The primary dressing of choice should consider the amount of drainage, undermining, tunneling and infection. The dressing choice will likely change as the wound heals and becomes more shallow with less drainage.
When an open wound is kept covered, there will be less chance for bacteria to penetrate the wound. A covered wound will have less direct trauma from friction and shearing with activity which can be another source of injury and delayed healing. Necrotic dead tissue and scabs will be softened and breakdown encouraged by keeping the wound covered. This may cause some concern if there is some yellow pus-like drainage forming, causing individuals to question if infection is starting. Signs of infection typically have some pain, swelling and odor associated and can be diagnosed by medical professionals. Some believe that airing out a wound is a benefit but essentially the wound healing is slowed by allowing for the wound to dry out. Drainage can be better managed by changing the dressing more frequently and using a more absorbent dressing.
How an open wound closes is through the proliferation of new tissue to fill in the open wound space. Multiple cells and biological processes work in concert to promote wounds to close. Cells migrate from the deepest point up to the surface and from the outside toward the center of the wound to fill in the space that was previously open. The new tissue that grows is granulation tissue so the cells are not exactly the same as the tissue that was lost in the injury. A wound is considered a closed wound when it is no longer draining and epithelial tissue has covered the entire surface. Epithelial scar tissue grows roughly 1 millimeter every 24 hours if protected and typically has a silvery appearance as it’s forming.
When wounds are closed, scars will take 6-24 months to fully mature. Scars will progress from a red, purple or dark color and fade over time. Scar shape and size will be affected by the kind of injury, healing process and history of scarring for the individual and family. Abnormal scars like keloids are often hereditary and may require specialized treatments to promote a flatter appearance. The greatest predictor of keloids are past keloids and a good thing to be aware of in order to seek medical advice early in the healing process for prevention.
Everyone will have an open wound injury at some point and scars are a natural part of the healing process. Superficial open wounds should heal within a few weeks when kept clean and covered. Wounds that are deeper and more complicated will take more time to heal. They should still continue to show progress every week if the wound presentation is adequately addressed through dressings, medical management of infection, pain and blood flow, nutritional support and mobility concerns.
©2020 Human Biosciences, Inc. The content presented here is for your information only. It is not a substitute for professional medical advice.