• Abrasion: A wound created by scraping or wearing away of the skin. These are partial-thickness wounds.
  • Burn: A wound created by thermal or chemical destruction of the skin and underlying tissues. These can be partial- or full-thickness wounds. Management of burn wounds is addressed in a separate guideline.
  • Puncture: A wound caused by a narrow object and results in a relatively small skin opening relative to the depth.
  • Laceration: A deep cut or tear in the skin.
  • Gunshot: A wound caused by a bullet; involves a high transfer of energy and extensive damage to tissues.
  • Blast: A complex wound that may involve penetrating fragments, extensive tissue damage or loss, and massive contamination with dirt and debris.
  • Crush injury: A wound caused by blunt trauma and may include injury to skin, muscle, or bone.

 

The overall principles of wound management are the same for each type of wound. The size of the wound and the evacuation timeline, as well as resources available and level of training of the medical provider, will influence the wound management plan. In most cases, open wounds with contamination, devitalization, loss of tissue (skin, muscle, or bone), or infection will require a more complex treatment strategy because of the invasive nature of the wound, especially in the context of war wounds. Large abrasions still require careful cleansing and dressing with a high index of suspicion for skin infection. Careful evaluation of the wound should lead to development of a problem list in the event PFC will be required. The care provider should focus on anesthesia, debridement and irrigation, wound dressing, antimicrobial therapy, scheduled dressing changes, and pain control. In select cases, delayed primary closure (DPC) may be considered.