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).