Summary
Highlights
Skin wounds are classified as open (skin not intact) or closed (skin intact). Closed wounds include contusions (bruises from trauma, discolored), hematomas (more severe trauma, blood pooling creating a hardened lump), blisters (fluid-filled pockets from friction, allergy, or burn), and frostbite (prolonged freezing exposure, affecting extremities, can cause tissue loss).
Open wounds include abrasions (scrapes on the top layer of skin, usually from friction, painful due to exposed nerve endings), lacerations (messy, irregular wounds from sharp objects or blunt trauma, bloody and painful), and incisions (intentionally created, symmetrical, neat wounds often surgical).
Additional open wounds are skin tears (shearing or stretching in fragile skin, common in elderly or corticosteroid users), puncture wounds (from sharp, narrow objects), penetrating wounds (deeper than puncture, affecting underlying tissues, e.g., gunshot), avulsion (serious, removes skin and underlying tissue, high infection risk), and burns.
Burns are skin damage from energy sources like heat or chemicals, categorized by depth. First-degree burns are superficial (epidermis only) and closed. Second, third, and fourth-degree burns are open wounds. Second-degree affects epidermis and dermis, painful with blisters. Third-degree affects all skin layers, destroys nerves, requires grafting. Fourth-degree destroys all layers, extending to muscle/bone, no pain, appears black/charred.
Pressure injuries, or pressure ulcers, develop from unrelieved pressure on skin, often over bony prominences or from medical devices. Stage 1 is intact skin, red, non-blanching (closed). Stage 2 is partial skin loss, no fatty tissue visible, may blister. Stage 3 is full skin loss, fatty tissue visible, rolled edges. Stage 4 exposes bone/muscle/tendons. Unstageable indicates full thickness covered by slough/eschar, depth cannot be assessed.
Chronic wounds, like venous and arterial ulcers, don't heal properly due to circulation problems. Venous ulcers result from poor venous circulation (blood pooling), common on lower legs and ankles, swollen, high drainage, irregular edges. Arterial ulcers result from poor arterial circulation (lack of oxygenated blood), found on toes, top of feet, lateral ankles, little drainage, pale, necrotic tissue, deep punched-out shape, painful, shiny/hairless surrounding skin.