Your Skin and Beyond Part 3

Know your wounds before you treat your wounds.

Joy Pape By Joy Pape, RN, BSN, CDE, WOCN, CFCN

Time to get back to wound care. We started discussing skin, the largest organ of your body. It’s good to understand your skin, the layers of your skin, and it’s underlying tissues, as well as prevention of skin breakdown before we get to this point of discussing actual wounds. It’s not always as simple as just putting on a Band-aid, especially with diabetes. This time around, we’ll mainly discuss wounds.

Wounds and ulcers

The word wound means an injury to living tissue caused by a cut, blow, or other impact, usually one where the skin is cut or broken. An ulcer is an open sore of the skin or mucus membranes that are difficult to heal. Although alike in some ways, their causes are what makes them different. They both come from various causes and vary in types, shapes, sizes, and depth. They will also require different types of treatment for healing.


Open wounds are wounds where the skin is cut, torn, or punctured by a sharp object.
Closed wounds don’t tear the outer layer of the skin but are caused by blunt trauma damaging the inner layers, such as a bruise. Open wounds are not necessarily more dangerous than closed wounds. Hitting your head against an object can cause bruising of the brain and be very serious. This is considered a closed wound. Stubbing one of your toes to where it is discolored but not open can also be dangerous if you have diabetes.

Minor and Major Wounds

Minor wounds are:

  • Superficial – they happen to the outer layer of your skin, the epidermis.
  • not near the natural openings of your body (eyes, ears, nose, mouth, urethra, vagina, rectum)
  • not heavy bleeders – not larger than the size of a dime, quarter, or silver dollar, and if more, the bleeding can be stopped.

For the most part, minor means a wound for which you don’t need to see a health care professional. But if you have diabetes, or if you are not sure, you should check it out.

Major wounds are:

  • any wound that doesn’t fit in to the above minor wound category.
  • considered severe – not always life threatening, but must be seen by a health care provider. This would be the case of a foot wound on someone with diabetes. It is best to have this examined to prevent further problems.
  • considered severe when there is a risk of a lot of blood loss that could lead to shock, or if there is an increased chance of infection, as in any open wound exposed to the elements.

Closed wounds can be just as severe as open wounds (see above regarding brain injuries) and for people with diabetes, closed wounds, especially on your legs and feet, can be serious.

Types of Wounds

Open Wounds

Open Wounds are classified into different types, mainly by what caused the wound.

  • Abrasions are superficial wounds when only the outer layer of your skin (epidermis) is scraped off, like when you fall and slide on your knee.
  • Incisions or incised wounds are caused by a clean sharp object such as a knife, razor, or even a glass splinter. An example would be a surgical incision. However, if it is only as “skin deep” as your epidermis, it is really considered a cut.
  • Lacerations are irregular wounds caused by a blunt object to tissue that covers a hard object (like when you hit your head and it bleeds) or by tearing the skin and other tissue as in childbirth.
  • Penetration wounds are caused by a knife or sword entering your body.
  • Puncture wounds are caused by an object that punctures your skin. A needle, ice pick, thumbtack, or nail would cause this.
  • Gunshot wounds are caused by a bullet or something with a similar force entering into or through your body. In this case there may be two wounds, the entry and exit wounds.

Please note, all gunshot and penetration wounds (stab wounds) are considered major wounds and should be seen by a health care professional whether you have diabetes or not.

Closed Wounds

  • Bruises (also known as contusions) are caused by trauma to soft tissue that causes damage to your small blood vessels (capillaries) and leakage of red blood cells. It is usually a red-to-purple discoloration and turns greenish-brown as it heals as it is reabsorbed into your skin. Hitting your luggage against your leg can cause this.
  • Crushing Injuries are caused by a lot of force on an area for a period of time. Being run over by a car can cause these.
  • Hematomas (sometimes called blood tumors) are caused by a break in a blood vessel under the skin that causes blood to collect. These can occur on their own as when a vessel is weak and breaks, as is the case of an aneurysm, or by trauma as in a hard fall.

Just like with monitoring, you want to not only know the problem, but the cause of it, and how to treat it correctly. This same principle applies to wounds and wound care. Hopefully this has helped you understand more about wounds. Next month we’ll talk about treatment for these types of wounds then move to skin ulcers and how to prevent and treat those.


Read Joy’s bio here.

Read more of Joy Pape's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

PREVIOUS: Your Skin and Beyond - Part 2 NEXT: Your Skin and Beyond - Part 4

Last Modified Date: November 27, 2012

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by Brenda Bell
As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...
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