What Are Closed Wounds?

Introduction

Closed wounds are injuries that occur beneath the skin's surface, where the skin remains intact.¹ They are not visibly open, unlike cuts or open wounds. Understanding closed wounds is crucial for effective first aid, injury prevention and overall healthcare. They can lead to complications if not treated properly.²

This article aims to provide a simple yet comprehensive overview of closed wounds, their types, characteristics, first aid, complications, prevention and more. Read on to explore these key aspects and empower yourself with knowledge about closed wounds.

Types of closed wounds

Closed wounds come in various forms, each with its own characteristics and appropriate treatments. Understanding these types is essential for proper care and management.

Contusion            

A contusion, commonly known as a bruise, is a closed wound caused by blunt force trauma to the skin or soft tissue.³ It leads to damaged blood vessels beneath the skin's surface, resulting in discoloration. Contusions typically occur due to accidents, falls, sports injuries or physical altercations. It includes pain, swelling and the characteristic purple or greenish skin discoloration. Treatment involves rest, ice, compression and elevation (RICE), over-the-counter pain relievers and time for the bruise to heal. Severe contusions may require medical evaluation.

Abrasion          

An abrasion is a superficial closed wound caused by the skin being rubbed or scraped against a rough surface, resulting in the removal of the outermost layer of skin. Abrasions commonly occur during falls, accidents or when the skin makes direct contact with abrasive surfaces.² Symptoms include pain, redness, swelling and a raw or grazed appearance of the skin. Cleaning the wound with mild soap and water, applying an over-the-counter antibiotic ointment and covering it with a sterile bandage can aid in the healing process. Tetanus shots may be necessary for deep or contaminated abrasions.

Laceration          

A laceration is a closed wound that involves a tear or cut in the skin and underlying tissue. Unlike open wounds, the skin remains in place but is damaged. Lacerations are often the result of sharp objects, accidents, or falls that cause a shearing force on the skin. Symptoms of lacerations include bleeding, pain and a visible wound with irregular edges. Treatment involves cleaning the wound, closing it with adhesive strips or sutures, if necessary, and keeping it covered with a sterile dressing. Deep or infected lacerations require prompt medical attention.

Puncture         

A puncture wound is a closed wound caused by a sharp, pointed object piercing the skin. It leaves a small, deep wound that may not bleed much. Puncture wounds can occur from stepping onto nails, from animal bites, or from other sharp objects.  Symptoms include pain, minimal external bleeding and potential entry of foreign materials or bacteria into the wound. Treating puncture wounds involves cleaning the wound thoroughly, applying antibiotic ointment and keeping it covered. Deep puncture wounds may require medical evaluation to prevent infection and ensure proper wound care.

General characteristics of closed wounds

Closed wounds have unique features that differentiate them from open wounds. Understanding these characteristics, along with the common locations and risk factors, is vital for comprehensive wound management and prevention.

Closed wound vs open wound

• Closed wound: closed wounds are injuries where the skin remains intact, with no visible break or opening in the skin. Examples include contusions, abrasions, lacerations and punctures.¹
• Open wound: in contrast, open wounds are injuries where there is a visible break in the skin or mucous membrane, allowing the external environment to come into direct contact with internal tissues. Examples include cuts, gashes, and punctures that break the skin's surface.² 

Common locations of closed wounds

Closed wounds can occur in various locations on the body, but some areas are more prone to specific types of closed wounds:

• Head and face: contusions from accidental head impacts or falls
• Limbs: abrasions from falls or sports-related incidents
• Hands and fingers: lacerations and abrasions due to handling sharp objects
• Feet: puncture wounds from stepping onto sharp objects, or from animal bites
• Trunk: contusions and abrasions from accidents or impacts

Several factors can increase the risk of sustaining closed wounds:

• Certain professions or activities, such as construction work or contact sports, carry a higher risk of injury.
• Children and the elderly may be more prone to falls and injuries.
• Uneven surfaces, clutter and slippery conditions increase the risk of accidents.
• Engaging in risky activities or not following safety guidelines can lead to closed wounds.
• Medical conditions that affect balance, coordination or skin integrity, such as diabetes, can increase the risk of injuries.

Understanding these risk factors can help individuals take preventive measures and reduce the likelihood of sustaining closed wounds. 

Complications of closed wounds

While closed wounds may not appear as severe as open wounds, they are not without risks. Understanding the potential complications and how to address them is crucial for a full recovery.

Infection

Closed wounds are susceptible to infection when bacteria, viruses or fungi enter the wound through microscopic openings, such as hair follicles or sweat glands, or from contaminants on the skin or foreign objects.⁴ Common signs of infection include increased pain, redness, swelling, warmth, discharge (pus), fever and an overall feeling of illness.

If infection is suspected, it is crucial to seek prompt medical attention. Treatment typically involves antibiotics, wound drainage and proper wound care. Severe infections may require hospitalisation and intravenous antibiotics.

Scarring

The development and extent of scarring after a closed wound depends on several factors. Deeper wounds are more likely to result in noticeable scars. Proper wound care, including cleaning and dressing changes, can minimise scarring.⁵ Additionally, individuals with different skin types may scar differently, and younger individuals tend to heal with less noticeable scarring. The location of the wound can also influence the visibility of scarring.

In terms of scar prevention and management, several strategies can be considered: 

• Proper wound care, involving cleaning, disinfecting and covering the wound, as directed by medical professionals. 
• Over-the-counter or prescription scar treatments, such as scar creams and ointments, may help reduce scar appearance. 
• Gentle massaging of the healing wound can help soften and flatten scars. 
• Products such as silicone sheets or gel can be effective in minimising scar visibility. 
• In cases where scarring is a significant concern, individuals should consult a healthcare provider for options such as laser therapy, steroid injections or surgical scar revision.

When dealing with a closed wound, assess it for signs of infection, swelling or pain. Gently clean it with soap and water, apply over-the-counter antibiotic ointment and cover it with a sterile bandage. Prioritise hygiene and handwashing. Seek medical help for deep wounds, signs of infection, face/hand/genital injuries or outdated tetanus vaccinations. This approach ensures that closed wounds heal properly.

Prevention of closed wounds

Preventing closed wounds is vital for safeguarding one's well-being and overall quality of life. This can be achieved through the implementation of safety measures and the creation of a safe environment to substantially decrease the risk of injuries.

Safety measures to reduce the risk of injuries

Employing the following safety practices can effectively minimise the likelihood of experiencing closed wounds:⁵ 

• Fall prevention: ensuring that homes and workplaces are equipped with proper handrails, non-slip flooring and clear walkways to reduce the risk of tripping and falling.
• Safe play: supervising children during playtime and ensuring they use age-appropriate toys and equipment.
• Sports safety: utilising appropriate safety gear, such as helmets, pads and protective clothing, when participating in sports and recreational activities.
• Proper handling: exercising caution when dealing with sharp objects, power tools and other equipment, while adhering to safety guidelines and workplace training.
• Caution in hazardous areas: taking extra care in areas that harbour potential hazards, such as construction sites or industrial environments.
• Protective equipment: depending on the specific activity or situation, the use of protective equipment plays a pivotal role in preventing closed wounds - examples are helmets, safety glasses, gloves and protective clothing
• Creating a safe environment: inspecting and maintaining your home regularly to detect and address possible dangers, such as loose rugs, uneven stairs or exposed cords; implementing safety procedures and offering training to minimise workplace accidents for employees.

By proactively adhering to these safety measures, utilising protective equipment when necessary and cultivating a safe environment, individuals can significantly diminish the risk of closed wounds, ultimately enhancing their overall safety and well-being.

Summary

Closed wounds, while not always visible, can lead to various complications, from infections to scarring, if not managed properly. By proactively implementing safety measures, wearing protective equipment and maintaining safe environments, individuals can greatly reduce the risk of closed wounds. In doing so, they promote not only their own safety but also the quality of life for themselves and those around them. Stay informed, stay safe and take steps to prevent closed wounds, ensuring a healthier, happier future.