SU5.3-4 | Wound Classification, Management and Medico-Legal Documentation — Summary & Reflection

KEY TAKEAWAYS

Wounds are classified two complementary ways. By morphology — incised (sharp, clean edges, length > depth), lacerated (blunt, ragged edges with tissue bridges), abrasion (superficial graze), contusion (bruise, intact skin), puncture/stab (small surface, dangerous depth), crush, avulsion/degloving, bite, burn — which tells the mechanism and associated injuries. And by the CDC surgical (contamination) classification — Class I clean (~1–2% SSI), II clean-contaminated (~3–5%), III contaminated (~10–15%), IV dirty/infected (>27%) — which predicts infection risk and guides closure and antibiotics. After ATLS-first assessment and investigation (checking deeper structures; radiographs/ultrasound/CT for foreign body, fracture or cavity penetration; swab if infected; explore generously), management follows an order: wound toilet, debridement, haemostasis, the closure decision (primary / delayed primary / secondary), tetanus prophylaxis by wound type and immunisation status, antibiotics (prophylactic or therapeutic, never replacing cleaning), dressing and follow-up. Finally, every wound is a potential legal injury: document accurately and objectively, prepare an injury report, know simple versus grievous hurt (IPC s.320), obtain consent and preserve evidence and chain of custody.

REFLECT

Think back to a wound you have seen managed in casualty or theatre. Could you name its morphological type and assign it a surgical contamination class? Was its management carried out in a logical order — toilet, debridement, haemostasis, an appropriate closure decision, tetanus and antibiotic prophylaxis — or were steps skipped? Was tetanus status actually checked? And if that wound had become the subject of a legal question weeks later, would the notes written at the time have been precise, objective and dated enough to stand up? How will what you have learned change the way you classify, manage and document the next wound you are responsible for?