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Wounds and Wound Care

Wound Care Facts

  • The skin is a barrier to the outside world protecting the body from infection, radiation, and extremes of temperature.
  • There are many types of wounds that can damage the skin including abrasions, lacerations, rupture injuries, punctures, and penetrating wounds.
  • Many wounds are superficial requiring local first aid including cleansing and dressing.
  • Some wounds are deeper and need medical attention to prevent infection and loss of function, due to damage to underlying structures like bone, muscle, tendon, arteries and nerves.
  • The purpose of medical care for wounds is to prevent complications and preserve function. While important, cosmetic results are not the primary consideration for wound repair.
  • Animal and human bites should always be seen by a medical professional because of the high rate of infection.
  • It is important to know a person's tetanus immunization status (for example, has the person had a tetanus shot or booster vaccine in the last 5 years?) so that it can be updated with a tetanus booster if needed.

Wound Overview

The skin is a large sensory organ that interacts with the environment, and sends signals to the brain about touch, pain, vibration, and position.

There are two layers of skin that cover the body, the epidermis and dermis.

The epidermis is the outermost layer of skin, the part that can be seen, and is very active with new skin cells being formed and gradually being shed. There are different kinds of epidermal cells:

  • Keratinocytes are the main skin cells that we see. New epidermal cells begin where the epidermis and dermis meet. These cells gradually mature and rise to the surface of the skin and are eventually shed to be replaced by new ones. The epidermis has no blood vessels and receives nutrition from the underlying dermis.
  • Melanocytes contain pigment and provide coloration to the skin and are responsible for absorbing radiation and protecting against the damage caused by ultraviolet radiation.
  • Langerhan cells are made in the bone marrow and migrate to the surface of the skin and help fight infection.
  • Merkel cells are specialized skin cells that help with sensing light touch. They are located on the tips of fingers and toes as well as other specialized areas.

The dermis is the deeper layer of skin. It has two layers that are responsible for supporting the epidermis:

  • The papillary dermis is a thin layer of tissue located just beneath the epidermis and contains capillary blood vessels and a few elastic and collagen fibers.
  • The deeper reticular dermis contains large bundles of collagen and elastic fibers that run parallel to the skin surface. The collagen and elastic fibers are responsible for helping the skin resist injury from shearing or other types of trauma, and allow the skin to return to its resting state after being stretched or compressed. This is the layer where hair follicles, sweat glands and sebaceous glands are found.

Subcutaneous fat tissue underlies the layers of epidermis and dermis and provides extra cushioning for the skin. Beneath this layer lie muscle and bone.

Picture of the layers of the skin including the epidermis and dermis layers

Medically Reviewed by a Doctor on 11/17/2017

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Patient Comments & Reviews

The eMedicineHealth doctors ask about Wounds (Care):

Wound Care - Treatment

What treatment was the best for your wound care?

Picture of Stitches

Stitches, Wounds, and Lacerations - Don't Fear the Needle

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Sewing is one of the fun things that we do in the emergency department. Repairing a laceration provides the immediate gratification of a job well done, seeing the skin edges come together to provide a nice scar, and it's one of the few times that the emergency doctor can sit down and spend time visiting with a patient.

While providing a nice scar is important, the two reasons we truly care for wounds is to make certain that the structures that run underneath the skin are not damaged and are functioning appropriately and that we can minimize the risk of infection. So it's with regret that I have to disagree with a quote in an article in USA Today by dermatologist Ranella Hirsch ("First aid made simple," by Kim Painter, 2007). She says that "Many doctors now use a medical super glue to close minor wounds. There's no painful stitching, and the wounds heal just as well, she says: "It's a win-win for everybody."

The implication made in Dr. Hirsch's take on stitching is that stitches hurt and that the skin is the most important thing in wound repair. But beauty is only skin deep, and while wounds may appear minor, they all need to be explored to make certain that things like tendons, nerves and joints haven't been damaged. And cleaning out the wound to remove debris is also a task that needs to happen before the skin gets sutured.

Read What Your Physician is Reading on Medscape

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