Traumatic wounds such as burns, lacerations and abrasions require specialized treatment to facilitate proper healing. Whether caused by an accident, surgery or injury, traumatic wounds can lead to complications like infections and impaired healing if not properly addressed. This article will provide a thorough overview of traumatic wound types, the healing process, and effective evidence-based treatments.
What is a Traumatic Wound?
Traumatic wounds are injuries to the skin and underlying tissues caused by external mechanical forces such as cuts, scrapes, punctures, blunt force trauma or burns. They penetrate multiple layers of the skin and often involve damage to blood vessels, nerves and other structures. Traumatic wounds may be accidental or intentional. Common causes include:
- Surgeries – Incisions made during surgical procedures
- Lacerations – Irregular tear-like wounds from a sharp object
- Abrasions – Scraped areas of damaged skin
- Burns – Tissue damage from heat, electricity, radiation or chemicals
- Human or animal bites
- Bullet wounds
Unlike chronic wounds linked to underlying medical issues, traumatic wounds are unplanned breaches in healthy skin. They require immediate first aid followed by further treatment to avoid complications.
The Traumatic Wound Healing Process
Healing traumatic wounds involves distinct overlapping phases aimed at repairing damaged structures and restoring skin integrity. This complex process includes:
Hemostasis Phase – After injury, blood vessels constrict and blood platelets aggregate to stop bleeding and form a clot. Chemical mediators are released to trigger the inflammatory cascade.
Inflammatory Phase – Leukocytes and macrophages migrate to the wound to breakdown debris, fight bacteria and prepare the wound for further healing. Inflammation peaks around 48 hours post-injury.
Proliferative Phase – Fibroblasts proliferate and lay down new extracellular matrix proteins like collagen to strengthen tissue. Angiogenesis occurs to build new blood vessels. Epithelialization involves epithelial cells migrating across the wound bed to cover it.
Maturation Phase – Type III collagen is replaced with stronger type I collagen to increase tensile strength. Non-functional cells undergo apoptosis. Final remodeling and realignment of tissue continues for up to 2 years.
Proper traumatic wound care facilitates this healing cascade while preventing disruptions that could cause complications.
Traumatic Wound Treatment Goals
The overarching goals of traumatic wound treatment include:
- Stop bleeding and promote hemostasis
- Prevent infection through cleansing and antimicrobial interventions
- Remove debris and necrotic tissue
- Maintain a moist wound environment conducive to healing
- Absorb exudate and manage wound fluids
- Reduce pain and protect newly formed tissue
- Promote granulation, epithelialization, and closure
- Optimize cosmetic results and function
Matching treatments to each patient’s wound promotes these goals and optimal healing outcomes.
Traumatic Wound Cleansing
Thorough wound cleansing is a critical first step in traumatic wound care. Irrigation with sterile saline or potable tap water helps remove debris, dirt and bacteria. Low pressure irrigation avoids driving contaminants deeper into tissue. Antiseptic solutions like chlorhexidine may also be used, especially for heavily contaminated wounds.
Cleansing should continue at each dressing change, with care taken around more friable wound beds. Avoid scrubbing or disturbing newly formed granulation tissue. Pat dry wounds gently after cleansing. Keep wound cleansing painless as possible.
Debridement of Traumatic Wounds
Debridement removes slough, eschar and other non-viable material that can impede healing and harbor bacteria. Sharp surgical debridement using scalpels or scissors is fastest but requires anesthesia and specialty training. Additional options include:
- Autolytic debridement – Allowing the body’s own enzymes to gradually debride devitalized tissue. Hydrogels and films help.
- Enzymatic debridement – Applying enzymatic agents like collagenase and papain to break down dead tissue.
- Mechanical debridement – Gently scrubbing with gauze or towels to abrade loose necrotic tissue.
- Maggot debridement – Using sterile fly larvae that secrete proteolytic enzymes to dissolve dead tissue.
- Hydrosurgical debridement – Using a high-powered water jet to cut and aspirate debris.
Debride devitalized tissue regularly until healthy granulation tissue is seen. Avoid damaging healthy structures.
Infection Prevention and Treatment
Traumatic wounds are at high risk for infection due to skin breaches and contamination. Warning signs of infection include:
- Increased pain, swelling, odor, exudate, or heat around the wound
- Redness spreading from wound margins
- Pocketing or undermining of wound edges
- Lack of wound improvement despite proper care
- Systemic signs like fever, nausea or malaise
Topical antiseptics, antimicrobial dressings and systemic antibiotics may be warranted if infection is present. Obtain wound cultures to guide antibiotic selection if unresponsive to initial treatment. Consider underlying risk factors like diabetes or immunosuppression when treating wound infections.
Advanced Dressings for Traumatic Wounds
Proper dressing selection promotes a moist wound environment while managing exudate and protecting fragile tissue. Considerations include:
- Foams – Absorb moderate to large amounts of exudate while insulating the wound. Better for cleaner wounds.
- Hydrogels – Provide moisture and cooling for light exudating wounds like partial thickness burns.
- Alginates – Highly absorbent dressings derived from seaweed that gel on contact with wound fluid. Useful for moderately to heavily exudating wounds.
- Hydrocolloids – Self-adhesive dressings that create moist environment and promote autolytic debridement. Not for heavy exudate.
- Collagen – Matrix dressings made of bovine or avian collagen that stimulate healing. Used for stalled, non-healing wounds.
- Antimicrobials – Dressings containing silver, iodine or other antimicrobial agents to prevent and treat infection.
Match the dressing absorbency and capability to each wound for best results. Change dressings when leaking, saturated or per facility protocols (typically every 1-3 days).
Chronic Wound Healing Treatments
For traumatic wounds showing impaired healing, advanced treatment options help overcome barriers to closure.
- Negative Pressure (NPWT) – Applying controlled subatmospheric pressure using a special pump and dressing helps draw wound edges together, reduce edema and promote perfusion.
- Biologics – Products like platelet-rich plasma deliver concentrated growth factors to stimulate cellular activity and healing.
- Skin grafts and substitutes – Placing autografts, allografts or cellular/tissue engineered skin grafts can help cover wounds and accelerate closure.
- Hyperbaric oxygen therapy (HBOT) – Increasing oxygen delivery to hypoxic wounds increases growth factor activity, angiogenesis and antibacterial defenses. Useful for problem wounds like diabetic foot ulcers.
Ensure proper patient nutrition and correction of any underlying issues hampering healing. Provide offloading, compression and other adjuvants as needed.
Special Considerations by Wound Type
Although basic principles remain the same, certain traumatic wound types warrant additional interventions:
Burns – Cool the burn immediately. Remove rings and constricting items. Estimate surface area and depth to guide treatment. Cover with antimicrobial dressings. Avoid disturbing blisters. Watch for signs of infection carefully in burns.
Skin tears – Gently realign torn skin flap after irrigating. Use skin closure strips or tissue adhesive to reapproximate edges. Protect with a non-adherent dressing. Educate on prevention.
Lacerations – Stop bleeding by applying pressure. Suturing is indicated for deep, long or gaping wounds. Tetanus prophylaxis and antibiotics may be warranted. Watch for signs of infection.
Bites – Vigorously irrigate with copious saline or antiseptic. Assess for tendon or bone involvement. Primary closure is controversial – may allow drainage if at high infection risk. Start antibiotics and monitor closely.
Abrasions – Cleanse gently. Apply antimicrobial ointment and non-stick dressings. Watch for signs of infection. Avoid picking scabs as they form.
Surgical wounds – Reinforce sterile technique. Watch for signs of surgical site infection. Protect incisions from shearing with dressings. Educate on proper incision care.
Match all interventions to the individual patient and their unique wound characteristics and needs. Provide patient education to prevent wounding and optimize at-home care. With proper assessment, treatment and monitoring, most traumatic wounds can heal free of complications. Consult wound specialists for hard-to-heal wounds requiring advanced therapies.
