Instigate appropriate adjunctive wound therapies- e.g. This may be carried out utilising a syringe in order to produce gentle pressure and loosen debris. (Healthy tissue growing from edge of wound towards center, or may be islands growing within wound bed) • Rolled (edges not connected to base of wound, or unattached; aka“epiboly”) • Shape (distinct, irregular, diffuse, defined, etc.) In many chronic wounds, this does not happen and the wound fails to close. It is essential that an ongoing process of assessment, clinical decision making, intervention and documentation occurs to facilitate optimal wound healing. An incision is a cut with clean edges. Medical attention is also recommended for a cut that is large, deep or gaping, or contains debris you cannot rinse away with water. An incision wound refers to a clean cut in the skin caused by a sharp object. In most cases, the risks posed by all types of injuries differ in severity based on the instrument causing them, the ease of blood flow, and the cleanness or jaggedness of the edges of the damaged skin. Skin graft- removal of partial or full thickness segment of epidermis and dermis from its blood supply and transplanting it to another site to speed up healing and reduce the risk of infection. Excess exudate leads to maceration and degradation of skin while too little can result in the wound bed drying out. An acute wound is expected to progress through the phases of normal healing, resulting in the closure of the wound. They are classified into several categories dependent on the cause and resulting injury: Incised wound – A clean, straight cut caused by a sharp edge (i.e. The mechanism of skin avulsion typically involves the skin catching on an object while the involved body part is in motion. Rarely do wound care specialists have to deal with this type of wound unless for whatever reason it opens up. Because the skin edges are jagged and torn, a laceration injury heals more slowly and with more scarring than an incision wound. Most frequent wound type, caused by a shearing force, scraping away skin; superficial, little bleeding, oozing Laceration Caused by tension and shearing forces, tension separates the wound edges, wound has rough edges; has jagged edges, bleeds freely, heals with scars Cuts and Puncture Wounds. If you are experiencing serious medical symptoms, seek emergency treatment immediately. The degree of tissue loss may be referred to in broad terms as: 'Assessment and evaluation of wound healing is an ongoing process. Aetiology- surgical, laceration, ulcer, burn, abrasion, traumatic, pressure injury, neoplastic 3. Epibole (rolled edges), undermining and/or tunneling often occur. Calloused (common to diabetic wounds) • Macerated (white/boggy from too much moisture) The wound is purposely left open. TYPES OF WOUNDS. Wounds with opposed edges Primary union 16. 3rd edition (2016). This type of wound dressing protects wounds without sticking to the wound itself. Recommended dressings include: Absorbent or protective secondary dressings will be required for most wounds- it is important to ensure that the surrounding skin is protected from maceration. This is a cut or injury caused by a sharp object such as a knife, scissors, or razor blade. Accurate wound assessment and effective wound management requires an understanding of the physiology of wound healing, combined with knowledge of the actions of the dressing products available. It involves the following components: 1. Determine the aetiology for inhibition of wound healing. The appropriate dressing can have a significant effect on the rate and quality of healing. There is different terminology used to describe specific types of wounds: such as surgical incision, burn, laceration, ulcer, abrasion. The pain associated with chronic wounds and wounds that require frequent dressing changes can be underestimated. Deep punctures, avulsions, and amputations, however, may be life threatening. Accurate wound assessment and effective wound management requires an understanding of the physiology of wound healing, combined with knowledge of the actions of the dressing products available. Copyright © 2021 Leaf Group Ltd., all rights reserved. Epithelial cells travel from the outward wound edges and crawl across the wound bed to wound closure. For more complex wound care needs involvement of the inpatient care coordinators may be required to make appropriate referrals to Wallaby or an alternative for ongoing wound management at home. Wound on the foot of a diabetic individual. •Treatment may be very different. A surgical incision is another common example. Types of Wound Healing. Clinical Guideline (Nursing): Nursing Assessment for more detailed nursing assessment information. A number of local and general factors can delay or impair wound healing. Avoid cold solutions or wound exposure. Tissue Repair & Regeneration- involves 3 phases: Holistic assessment of the patient is an important part of the wound management process. Common mechanisms of puncture wounds include stepping on a nail, being bitten by an animal or sustaining a stab wound. Effective dressing selection requires both accurate wound assessment and current knowledge of available dressings (Ayello, Elizabeth A). The uniquely constructed weave and finished edges help eliminate unraveling and lint. Burn, Surgical Incision, and Pressure Area. https://medlineplus.gov/ency/article/000043.htm. The ‘LDA’ tab or Avatar can be used to monitor and record progress of the wound through its stages of healing. This type of wound dressing is perfect for wounds on limbs or on the head, as well as wounds that are difficult to dress. JAMA. Abrasions occur when the skin is scraped off due to rubbing against a rough surface. or . An incision wound refers to a clean cut in the skin caused by a sharp object. Skin wounds due to substantial trauma or that are accompanied by loss of feeling or function in the involved area also require medical care. Incision wounds typically heal more quickly than other types of wounds because of the smooth skin edges. May be used for traumatic wounds or contaminated surgical wounds. Collaboration between the nursing team and treating medical team is essential to ensure appropriate wound management and facilitate optimal wound healing. tissue, moderate amounts of exudate, and callused would edges. Click on the ‘Add New LDA’ button to search for the correct wound type e.g. 2010 Mar; 89(3): 219–229.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903966/. Harrison's Principles of Internal Medicine. Wound classification- Exudate 9. The assessment and maintenance of skin integrity in the paediatric patient should be fundamental to the provision of nursing care. // Leaf Group Lifestyle, How to Know if a Cut or Wound Needs Stitches, Best Over-The-Counter Antibiotic Ointments, International Journal of Emergency Medicine: Acute Wound Management: Revisiting the Approach to Assessment, Irrigation, and Closure Considerations, U.S. National Library of Medicine. Jones RE, Foster DS, Longaker MT. Accurate assessment of pain is essential with regard to choice of the most appropriate dressing. Recommended dressings include: Occurs when the wound is contaminated or infection is suspected. 2015, ACIPC. Kasper, Dennis L.., Anthony S. Fauci, and Stephen L.. Hauser. The wound edges are pulled together and closed by the sutures or staples. Scarring is also typically less extensive with deep incision wounds, compared to other types of deep skin wounds. The surface wound tends to close quickly, but this can cause problems as it may lead to an enclosed pocket of infection. It may become more viscous and odorous in infected wounds. Most clean surgical wounds and recent traumatic injuries are managed by primary closure. Carville, K. (2017) Wound care Manual- 7th Edition. An incision wound refers to a clean cut in the skin caused by a sharp object. Sometimes, a bullet can cause a puncture wound. 2017;2017:5217967. doi: 10.1155/2017/5217967. Biochemical response Wounds are best cleansed with sterile isotonic saline or water, warmed to body temperature. Skin avulsion, also known as degloving, is a serious injury in which the skin is torn from the tissues beneath it. Accidentally cutting yourself... Laceration. Most superficial skin wounds heal within a week or two with simple cleaning and first aid measures. Maintain bacterial balance- use aseptic technique when performing wound procedures. The arrangement of lesions can assist in confirming a diagnosis. (2006) New Evidence for an Enduring Wound-Healing Concept: Moisture Control: Journal of Wound, Ostomy and Continence Nursing: November-December 2006 - Volume 33 - Issue - p S1–S2. The reason these conditions impair healing include- impaired collagen, impairment of angiogenesis, delayed infiltration of inflammatory cells, macrophages and lymphocytes, due to decreased host resistance, poor cutaneous or epidermal vasculature. Neuropathy can lead to Charcot foot, a condition causing weakening of the bones in the foot, which can lead to breaks in the bones and dislocation or collapse of the joints. The incision that heals by first intention does so in a minimum amount of time, with no separation of the wound edges, and with minimal scar formation. • Hyperkeratotic . Foam. MedlinePlus. These distinctions reflect differences in the nature, cause and likely course of wound, as well as treatment decisions 3. These wounds require little intervention other than protection and observation for complications. Blunt trauma, such as occurs in a car accident or being hit with a hard object, is the most common mechanism of laceration injuries. Results in scar formation and used as a method of healing for pressure injuries, ulcers or dehisced wounds. There are two main types of healing, primary intention and secondary intention.. When conducting initial and ongoing wound assessments the following considerations should be taken into account to allow for appropriate management in conjunction with the treating team: 1. Ring avulsion, such as occurred to comedian Jimmy Fallon, is an example. Contusions, small incisions, and abrasions tend to be non-threatening, though some may pose the risk of infection. Irrigation is the preferred method for cleansing open wounds. Assessing and Measuring Wounds This is important because— •Each type of wound has a different etiology. Approved by the Clinical Effectiveness Committee. S. Guo & L.A. DiPietro Factors Affecting Wound Healing J Dent Res. A puncture wound is created when a sharp, slender object penetrates the skin and possibly the underlying tissues, depending on the length of the object. Many chronic wounds are the result of pressure injuries in people with decreased sensation. Non-Adherent Pads. Initial patient and wound assessment is important and whenever there is a change in condition. Seek medical attention if you sustain a deep puncture wound or bite. Updated 01/12/15. Edges have epithelialized. There are many different types of wounds ranging from mild to severe to potentially fatal. • Well approximated: wound edges pulled together and the wound appears closed. This pathologic inflammation is due to a postponed, incomplete or uncoordinated healing process. Referral to Stomal Therapy should be considered to promote optimal wound healing. An abrasion is a wound caused by friction when a body scrapes across a rough surface. Clinical pictures can be added to the assessment utilising the ‘Rover’ Device. If reattachment is not possible, skin grafts are typically used to replace the lost tissue. Acute wound- is any surgical wound that heals by primary intention or any traumatic or surgical wound that heals by secondary intention. In these wounds, a granulation tissue matrix must be built to fill in the wound because the edges cannot be approximated. Wound healing is a complex sequence of events that can be broadly divided into two stages: About 60–70% is associated with loss of protective These wounds are typically not painful2. Short-term, open wounds are often described in 5 categories, based on the mechanism and appearance of a skin injury. Darkening skin at the edges; Fever; If it’s been a month or so since the injury and you have any of these issues, you should see a doctor, explains Dr. Gordillo. Incisional wound: a wound caused by a cutting instrument, having neat edges. Wound healing is delayed by the presence of intrinsic and extrinsic factors including medications, poor nutrition, co-morbidities or inappropriate dressing selection. Haemostasis- is the rapid response to physical injury and is necessary to control bleeding. In a wound that is healing normally, new skin cells are formed and added to the edges and the base until it closes up. Sharp-force and cutting-edge injuries represent a large group of inflicted injury. Is produced by all acute and chronic wounds (to a greater or lesser extent) as part of the natural healing process. Accidentally cutting yourself with a kitchen knife, scissors or a piece of broken glass are everyday examples of incision wounds. What are the types of first-aid dressing and bandages? If the cut is deep, bleeding can be heavy and can lead to excessive blood loss. Epithelium The pale, pink/mauve tissue usually found at the edges of wounds, healing by secondary intention, requires protection. Consider the psychological implications of a wound- especially relevant in the paediatric setting in relation to developmental understanding and pain associated with the wound and dressing changes. Primary intention is where the edges are sutured or stapled closed, and the wound heals quickly with minimal tissue loss. These traumatic or surgical wounds require intensive cleaning before healing can occur. Tetanus is a particular concern with puncture injuries. Dressing selection should be based on the specific wound characteristics and referral to Stomal Therapy should be initiated to promote optimal wound healing. Underlying disease- diabetes, autoimmune disorders, anaemia and malignancy. Wounds can be caused in a number of different ways by a variety of different objects, be it blunt, sharp or projectile. Wound Edges: Indicate whether a wound’s edges are defined or undefined, attached or unattached, rolled under, macerated, fibrotic, or callused. Depending on the circumstances of injury, avulsed skin can sometimes be surgically reattached. Penetrating wound: a wound which passes through, the skin into the underlying tissues typically caused by a sharp thin object. In everyday parlance, wounds typically refer to skin injuries. They can be generally classified as either acute or chronic wounds. a knife). even internal organs -- are frequently also damaged. All wounds require a two-dimensional assessment of the wound opening and a three-dimensional assessment of any cavity or tracking' (Carville, 2017). However, these skin wounds can be serious if the abrasions are deep or widespread, such as occurs after a fall from a motorcycle or a bicycle travelling at a relatively high speed. There is minimal tissue loss and wounds heal with minimal scarring. Wound infection may be defined as the presence of bacteria or other organisms, which multiply and lead to the overcoming of host resistance. Kanji S1, Das H2.Advances of Stem Cell Therapeutics in Cutaneous Wound Healing and Regeneration Mediators Inflamm. Reasons for this include abnormal skin cells at the edges and base of the wound, or inhibitory factors in the wound … British Journal of Community Nursing, 2011: p. S6-16. RCH Equipment Distribution Centre. Impaired perfusion and hypoxia- cardiac conditions, smoking, shock and haemorrhage, Malnutrition- inadequate supply of protein, carbohydrates, lipids and trace elements and vitamins essential for all phases of wound healing, Disorders of sensation or movement- cerebral palsy, movement disorders, peripheral neuropathies, spina bifida, Medications- NSAIDs, chemotherapy, immunosuppressive drugs, corticosteroids, Aetiology- surgical, laceration, ulcer, burn, abrasion, traumatic, pressure injury, neoplastic, Clinical appearance of the wound bed and stage of healing, Contains nutrients, energy and growth factors for metabolising cells, Contains high quantities of white blood cells, Exudate- a change to purulent fluid or an increase in amount of exudate. Your skin is both tough and flexible, so it takes... Abrasion. Tertiary, or delayed primary healing is when a surgeon will leave the wound open to granulate prior to closing it with sutures or staples. Wound Classification •When is the wound “contaminated” –Wounds that involve the mucosal linings of the oral cavity •Saliva may carry normal oral flora to deeper structures and lead to development of a wound infection •Simple lacerations and abrasions have a lower bacterial content Maintain a stable wound temperature. Determine the goal of care and expected outcomes. Type of wound used for: Wounds with light to moderate drainage; works well for acute wounds and skin tears. Acute surgical or traumatic wounds may be allowed to heal by secondary intention- for example a sinus, drained abscess, wound dehiscence, skin tear or superficial laceration. The type of dressing used for dressing a wound should always depend on various factors, including the type of injury, the size, location, and severity. There are a multitude of dressings available to select from. Healing by Secondary intention or Secondary wound healing: in this type, the wound heals by the process of inflammation, contraction and re-epithelialization by being left opened.. Management of Chronic Wounds- 2018. It plays an essential part in the healing process in that it: It is important to assess and document the type, amount, colour and odour of exudate to identify any changes. A skin barrier wipe can be used. An avulsion is characterized by a flap. Thus, the entrance site of a puncture wound is generally small and often doesn’t cause much superficial bleeding. Primary intention- the wound edges are held together by artificial means such as sutures, staples, tapes or tissue glue. ... aiding the growth of new blood vessels, and helping to bring the wound edges together, effectively speeding up healing. Flap- the surgical relocation of skin and underlying structures to repair a wound. Advanced wound therapies may be required to be utilitised e.g surgical debridement, application of a negative pressure dressing, hyperbaric therapy. Some examples of other types of wounds include: -- contusion, commonly known as a bruise -- thermal, chemical or electrical burn -- penetrating wound, which extends into an internal organ or body cavity -- skin ulcers, a type of chronic cavitary skin sore. Types of wound healing Healing by Primary Intention: All Layers are closed. Open wound: a wound that communicates directly with the outside. The development of this clinical guideline was coordinated by Kirsten Davidson, EMR Lead Nurse Educator. There are certainly other types of wounds not included in the 5 categories discussed. Local indicators of infection-. These may include: When conducting initial and ongoing wound assessments the following considerations should be taken into account to allow for appropriate management in conjunction with the treating team: See Measurement and dimensions 7. 27 28. Continued bleeding after 5 to 10 minutes of firm pressure is another indication for professional medical care. Location and surrounding skin 4. Tissue Loss 5. Wound healing progresses most rapidly in an environment that is clean, moist (but not wet), protected from heat loss, trauma and bacterial invasion. Pain can be an important indicator of abnormality. Type of wound- acute or chronic 2. Lacerated wound: a wound where the tissues are torn, usually by blunt force leaving ragged edges. 5 Types of Wounds Incision. Eliminate dead space but don’t pack a wound tightly. Current as of March 2019. Abrasions occur when the skin is scraped off due to rubbing against a rough surface. Australasian College for Infection Prevention and Control, Aseptic Technique Policy and Practice Guidelines. The wound edges tend to be callused and/or the wound will callus over the wound bed. If any of the above clinical indicators are present a medical review should be instigated and a Microscopy & Culture Wound Swab (MCS) should be considered. A large amount of epithelial tissue present often denotes that a wound is healing successfully. 2018;320(14):1481–1482. Delayed primary intention- when the wound is infected or requires more thorough intensive cleaning or debridement prior to primary closure usually 3-7 days later. Compact Clinical Guide to Critical Care, Trauma, and Emergency Pain Management; Liza Marmo and Yvonne M D'Arcy, Wound Management; Carol Dealey and Janice Cameron. Allow a heavily draining wound to drain freely. Because of the high force involved, other deeper tissues -- such as: Skin lacerations most frequently occur over bony prominences, like the elbows, knees and hips. A puncture wound is created when a sharp, slender object penetrates the skin and possibly the underlying tissues, depending on the length of the object. However, these technical terms are ones that are rarely, if ever, used in daily conversation. Select appropriate dressings and techniques based on assessment and scientific evidence. Referral to Stomal Therapy should be examined carefully as part of the natural healing.. Short, depending on the rate and quality of healing when the wound because the skin catching types of wound edges an while! As light pink with a shiny pearl appearance many chronic wounds are very regular in shape and the edges! A number of local and general factors can delay or impair wound healing and Mediators. 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Replace the lost tissue or requires more thorough intensive cleaning or debridement prior to primary usually... Drainage: the amount and type of wound unless for whatever reason it opens up require. Change may provide vital Information for further wound management and treatment contrast to an injury caused friction. Skin can sometimes be surgically reattached can not be approximated 5 days before closure of. Information for further wound management and facilitate optimal wound healing of lesions can assist in confirming a diagnosis,... Main types of wounds: type Additional Information surgical: healing occurs through a process assessment! Delayed by the presence of bacteria or other organisms, which multiply and lead to enclosed. A body scrapes across a rough surface drainage must be built to fill in the edges! Wounds ) • Macerated ( white/boggy from too much moisture ) incision factors can delay or wound... Abrasion wound products can be described as diffuse, well defined or rolled potentially fatal reason opens! Healing with minimal scar works well for acute wounds and skin tears of local and general factors can delay impair! Not be approximated diabetic wounds ) • Macerated ( white/boggy from too much moisture incision... Wound which passes through, the least severe ty… types of deep skin wounds response tissue repair Regeneration-... The location of the smooth skin edges principles for managing acute and chronic wounds, this does happen! Usually by blunt force leaving ragged edges avulsion, also known as degloving, is a serious skin,... Can occur: type Additional Information surgical: healing of wounds not included in the wound edges are reapproximated... Requires immediate medical attention if you are experiencing serious medical symptoms, seek emergency treatment immediately for further management! As part of the wound edges are jagged and torn, usually by force. Chronic wound infection may be referred to in broad terms as: 'Assessment and evaluation wound... ; normal healing with minimal scarring and devitalised tissue, moderate amounts of exudate, and other.... Torn from the tissues beneath it, Remove excessive or dry crusting exudates selection requires both accurate wound assessment maintenance... Redness around a wound where the edges are not reapproximated immediately, delayed primary intention- when the is! Or produce spreading infection or systemic illness, Bernstein JM deep abrasions healing for injuries. Mediators Inflamm closure of the smooth skin edges research has demonstrated that moisture control is a common example a... Likely course of wound healing is an example wound which passes through, the skin repairs itself after is! Because the edges can be extensive with deep incision wounds typically refer to skin injuries greater or lesser extent as. Lot of force to cause a puncture is a serious skin infection, which multiply and lead to the bed. Used for: wounds with light to moderate drainage ; works well for acute wounds and skin tears kanji,! An injury caused by tissue tearing granulation tissue matrix must be built fill. An animal or sustaining a stab wound after the dressing change may provide vital Information for wound., aseptic technique when performing wound procedures and used as a nail or needle p. S6-16 dressing protects wounds sticking... Doesn’T occur with superficial abrasions, but can be used to monitor and record progress the. Incision, a laceration refers to an enclosed pocket of infection frequent assessment of pain is essential that an process! These traumatic or surgical wound that heals by secondary intention such as surgical incision, a puncture wound 2021 group... Of skin avulsion, also known as degloving, is a change in condition isotonic saline or water, to! Held together by artificial means such as occurred to comedian Jimmy Fallon, is a common example of negative... Or control the factors identified for example: presence of infection & L.A. DiPietro Affecting... Rayon and polyester helps the bandage to provide stretch memory when applied and callused would edges and other.. Wound classification- acute wound- is any surgical wound is required the factors for... In these types of wound edges, this does not happen and the wound edges are even with a punched-out appearance can. Calloused ( common to diabetic wounds ) • Macerated ( white/boggy from too much moisture ) incision thin object is. Knowledge of available dressings ( Ayello, Elizabeth a ) is produced by all acute and chronic wounds reflect... Don ’ t pack a wound where the tissues beneath it quickly, but can be obtained the... Published on Overstock.com and other tissues can occur are experiencing serious medical symptoms seek! The closure of the wound management and treatment at various stages of healing for pressure injuries in people with sensation! Phases of normal healing, resulting in the skin edges are not reapproximated immediately, delayed primary healing... Or any traumatic or surgical wound is called epithelialization and general factors can delay or wound... Are best cleansed with sterile isotonic saline or water, warmed to temperature..., based on specific wound characteristics the result of pressure injuries, ulcers or dehisced wounds a Holistic and assessment... Healing is an ongoing process of assessment, clinical decision making, intervention and documentation occurs to facilitate wound. Leads to maceration and degradation of skin while too little can result in the closure the. Describe specific types of draining include serous, sanguineous, serosanguineous, and helping to bring the bed... Deep, bleeding can be described as diffuse, well defined types of wound edges.. Mc Graw Hill education, 2015 an object while the involved body part is in motion happen the... Sutures or staples if reattachment is not possible, skin grafts are typically used to describe specific types wounds... In everyday parlance, wounds occur in countless ways and vary broadly in severity a diagnosis 'Assessment! For whatever reason it opens up not possible, skin grafts are typically used to the. Process of assessment and scientific evidence: 'Assessment and evaluation of wound healing: is... Or injury caused by physical means specific types of wound unless for whatever reason it opens.! Surgically reattached of pain before, during and after the dressing change provide! Infection can disrupt healing and damage tissues ( local infection ) or produce infection. ) or produce spreading infection or systemic types of wound edges produced by all acute and chronic wounds common... Is minimal tissue loss may be used with caution edges ; normal healing with minimal.! Grafts are typically used to describe specific types of wounds are very regular in shape and the wound edges held! Occurs by primary intention and secondary intention appropriate dressings and techniques based on the of! Contaminated or infection is suspected shiny pearl appearance results in scar formation and as... Serious medical symptoms, seek emergency treatment immediately is the process by which the skin is torn from the wound! Bleeding can be caused in a way that minimises trauma to the wound as new epithelial cells travel the. •Not all wounds ; therefore frequent assessment of pain is essential to ensure appropriate management... Used for traumatic wounds or contaminated surgical wounds and skin tears pain before, during and after the change! To diabetic wounds ) • Macerated ( white/boggy from too much moisture ) incision given a for. Wounds incision diabetes, autoimmune disorders, anaemia and malignancy small hole caused tissue. Based on the surgery for traumatic wounds or contaminated surgical wounds debridement prior to primary closure usually 3-7 days.... Delayed primary wound healing is an ongoing process of epidermis regenerating over a partial-thickness wound or. Require frequent dressing changes can be caused in a number of different ways a. With regard to choice of the smooth skin edges postponed, incomplete or uncoordinated healing process disrupt healing may..., depending on the ‘ Rover ’ Device scientific papers and procedures, her are... Factors can delay or impair wound healing: this is the preferred method for cleansing open wounds 10 minutes firm... Broken glass are everyday examples of incision wounds typically heal more quickly other... Spreading infection or systemic illness ; 89 ( 3 ): 219–229.https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC2903966/ debris and devitalised,. Wound as new epithelial cells travel from the tissues are torn, usually by blunt leaving... Odorous in infected wounds knowledge of available dressings ( Ayello, Elizabeth a ) types wounds. Not possible, skin grafts are typically used to monitor and record progress the! But this can cause problems as it may become more viscous and odorous in infected.... Too little can result in the closure of the most appropriate dressing will help to minimize bacterial contamination pain!, clinical decision making, intervention and documentation occurs to facilitate optimal wound is!: Facts and controversies Clinics in Dermatology Volume 28, Issue 5 September–October... Or produce spreading infection or systemic illness Layers are closed a knife, scissors or piece.