Classification of wound

A wound can be caused by almost any injurious agent and can involve almost any tissue or structure. The most useful classification of wounds from a practical point of view is that of Rank and Wakefield into tidy and untidy wounds.

Tidy wounds

Tidy wounds are inflicted by sharp instruments and contain no devitalised tissue (Fig. 3.6); such wounds can be closed primarily with the expectation of quiet primary healing. Examples are surgical incisions, cuts from glass and knife wounds. Skin wounds will usually be single and clean cut. Tendons, arteries and nerves will commonly be injured in tidy wounds, but repair of these structures is usually possible (Fig. 3.7). Fractures are uncommon in tidy wounds.

 Untidy wounds

Untidy wounds result from crushing, tearing, avulsion, vascular injury or burns, and contain devitalised tissue (Fig. 3.8). Skin wounds will often be multiple and irregular. Tendons, arteries and nerves may be exposed, and might be injured in continuity, but will usually not be divided. Fractures are common and may be multifragmentary. Such wounds must not be closed primarily; if they are closed wound healing is unlikely to occur without complications. At best there may be wound dehiscence, infection and delayed healing, at worst gas gangrene and death may result. The correct management of untidy wounds is wound excision, by this is meant excision of all devitalised tissue to create a tidy wound. Once the untidy wound has been converted to a tidy wound by the process of wound excision it can be safely closed (Fig. 3.9) (or allowed to heal by second intention).