Dermatology-Online

Lacerated wound

What is a tear wound?

Tear wounds are mechanical wounds. As the name suggests, the skin tears open when force is applied, usually with a blunt object. This creates uneven wound edges and tissue bridges, i.e. the tissue under the skin is not completely separated, but partly still connected to the opposite side like bridges. As a rule, there are also bruises in the case of lacerated wounds, which are referred to as cracked contusions. Crack wounds can be very deep and bleed profusely.

Also read the article on the topic: Bruises

Causes of a laceration

Tear wounds are caused by tensile forces and blunt force, caused by a blunt object. Tear wounds are also often found in traffic accidents. If high pressure is exerted on the skin, it will give way at a certain point and tear.

If, in addition, tension is exerted along the surface of the skin, the layers of the skin shift against each other and also tear. This can run through all layers of the skin except for the muscle or bone. Since the force is not exerted evenly, the wound edges are uneven. Tissue bridges can remain in the depth.

How does a laceration differ from a laceration?

In the case of a laceration, only the top layers of skin usually tear / burst. This is especially the case on parts of the body with little subcutaneous fat, where the skin lies directly on the bones, such as on the head, knee, shin, or elbow.

In the case of a tear wound, deeper layers of the skin can also be affected, in the worst case down to the muscle or bone. Tissue bridges can often be seen in the depth and the wound edges are frayed or uneven. Lacerations can occur anywhere on the body. However, areas with little subcutaneous tissue are also predisposed to this.

Also read the article on the topic: Laceration

localization

On the finger

Torn wounds on the finger can e.g. caused by hitting the finger with a hammer. The tissue is crushed by the impact until it tears. The transition from crushed to cracked wounds is often fluid and cannot be clearly distinguished. Here, too, the wound edges are uneven and can only be adapted (joined) with difficulty.

As a rule, there is not much subcutaneous fat on the finger to dampen the impact. The skin is quickly pinched and torn between the blunt object and bone. The finger swells very quickly and can bleed profusely. The hands and fingers in particular are supplied with many small nerves. Injuries to the fingers are therefore very painful. It comes to throbbing pain especially when the fingernail is affected and blood builds up under the nail.

On the knee

Tear wounds on the knee are usually caused by falls. When you fall on hard ground, the tissue between the ground and the kneecap is squeezed until the skin bursts. If you slide a little over the floor, tensile forces are added, which tear the skin and deeper tissue layers. The knee swells and pain-related impaired mobility in the knee joint can occur.

In addition, if you fall on your knee, you can always break the kneecap. Since the skin above the knee is always in motion when walking, wound healing is more difficult and sometimes more time-consuming. The knee should first be immobilized.

On the shin

Torn wounds on the shin are also mostly caused by a fall or a kick. Here, too, the tissue under the skin is very thin, so it is easily squeezed and torn. Fall wounds are often made dirty by dirt on the floor and need to be cleaned carefully.

diagnosis

A tear is always preceded by a mechanical force. After a thorough inspection of the wound edges and depth of the wound, a tear wound diagnosis can be made. The wound and teardrop are irregular.
Tissue bridges can typically be found deep down, which are caused by uneven forces acting on the skin. Often tears and bruises are combined with one another and cannot be clearly distinguished from one another.

Accompanying symptoms of a lacerated wound

The skin is sensitively supplied by many nerves. If these are damaged by sudden tearing of the skin, severe initially stabbing pains occur, which can sometimes cause general symptoms such as dizziness, a drop in blood pressure and even fainting.

This is followed by pulsating pain in the area of the wound. Crack wounds can bleed profusely, especially if deeper sections of the skin are affected. In addition, there is swelling around the wound as fluid collects in the damaged tissue.

Find out more about the topic: Pus in a wound

Treatment / therapy

The primary goal of wound care is to stop bleeding. First, pressure should be applied to the wound. To do this, you put a sterile compress on the wound and apply a pressure bandage over it. A doctor should then be consulted. If the bleeding has been stopped by the bandage, if a bone fracture is suspected, an X-ray is taken first. The bandage is then removed and the wound examined.

Also read the article on the topic: First aid for wounds

The wound is cleared of coarse dirt and disinfected. Depending on the size and location, the wound must be sutured or stapled. For minor injuries, it is sufficient to fix the wound edges with adhesive plasters. Before suturing the wound, a local anesthetic is injected into the tissue around the wound for local anesthesia. After a short exposure time, the wound is again thoroughly cleaned in depth and then covered in a sterile manner.

The wound is now sutured under sterile conditions. Depending on how deep the wound is, deeper layers of the skin may have to be sewn separately first. At the end, the top layer of skin is sewn together. In the case of lacerated wounds, the wound edges often have to be straightened in advance by cutting off protruding skin corners. The skin is elastic, the straightened wound edges can then be pulled together.

At the end, a plaster and bandage are put on. The area should then be cooled, stored up and protected. In addition, the wound should be kept dry and the dressing changed regularly until the wound has healed. In addition, the tetanus vaccination status of the patient is queried for every skin injury, especially in the case of soiled wounds, and a tetanus vaccination is given if the vaccination protection is unclear or insufficient. Otherwise tetanus may occur.

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When do I have to see a doctor with a tear?

In any case, a doctor should be consulted if the tear wound is deeper or longer than 1 cm. It can be assumed that the wound will not heal on its own, as the wound edges cannot be attached to one another and must be fixed by the doctor with sutures, staples or plasters.

In the case of coarse soiling or heavy bleeding, a doctor should also be contacted. In addition, if there is a suspicion of accompanying injuries such as a broken bone.

Torn wound complications

As with any injury, the wound can become infected. The skin barrier is defective and germs can penetrate the skin from the outside and multiply there. If this gets into the bloodstream, in the worst case scenario, the infection can spread throughout the body. Torn wounds can bleed profusely and be very painful.

This article might also interest you: Inflammation of a wound

This can lead to general symptoms such as a drop in blood pressure or even fainting. Tearing the layers of tissue can damage superficial or deep nerves. Sensitive skin nerves are particularly often affected, which may no longer regenerate and a sensory disorder / numbness persists in the area of the wound. In the case of deep wounds or poorly adapted wound edges, wound healing disorders can occur. Likewise with additional bruises.

Read more on the topic: Wound healing disorder

Healing time of a tear wound

The healing time depends on the severity of the injury and the location. Deep wounds, which are also badly squeezed and the wound edges could only be joined with difficulty, require significantly more time for healing. Seams may even have to be renewed after a few days.

Small lacerated wounds with well-adapted wound edges usually heal in 10-14 days, after which the sutures can be removed. Torn wounds on parts of the body that are exposed to greater stress through movement (e.g. fingers, knees) can also take a little longer to heal. The affected part of the body should be kept as calm as possible until the wound has healed so as not to unnecessarily irritate the skin.

Find out more about the topic: Phases of wound healing