Lacerated wounds

Lacerated wounds are caused by blunt instruments or by blows which tear the tissues. The edges of lacerated wounds are ragged, and there is more damage to the tissues than in incised wounds. There is usually more marked contamination, and the susceptibility to infection is greater.

You should cut away flaps of devitalized skin if the blood supply is insufficient. You should remove all foreign material and control bleeding. The treatment of lacerated wounds is identical to incised wounds.

Puncture wound.

Puncture wounds are wounds inflicted by pointed instruments such as a nail. They require no surgical treatment unless important structures have been damaged. But it is necessary to immobilize the part.

In puncture wounds of the foot the patient should use crutches. If he walks on the foot, infection will occur. A tetanus antitoxin should be given. If infection occurs, it is necessary to open the patient’s wound without delay.

Puncture wounds through the soft tissues if the arm or leg may be treated by immobilization of the extremity and application of a pressure dressing.

Puncture wounds of the abdomen should be explored if there is any possibility that the peritoneal cavity has been entered.

Abrasion.

Abrasions are caused by friction. The epidermis and some of the deeper layers of the skin are lost. The base is left and it is identical to a second degree burn. You should treat these wounds as burns, wash clean to remove any dirt and cover with a bland ointment or vaseline gauze dressing. A pressure bandage and immobilization will hasten healing. If there is no infection of the wound, the dressing should be left in place for ten days by which time complete epithelization will have occurred. The early removal of dressing is painful and disturbs the new epithelium, which adheres to the dressing.

Avulsion

When pieces of skin and subcutaneous tissues are avulsed, the defect should be closed by primary suture or covered with a skin graft. A skin graft will grow on periosteum, tendon sheath, fat, or fascia and it should be applied even if the blood supply to the base of the wound is not very promising. Skin is nourished by the lymph and will survive well if not much contamination is present.

Fill in the table using the information from the text

The types of wounds (виды ран)	The cause of the wound (причина раны)	The description of the wound (описание раны)	The treatment of the wound (лечение раны)
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