Penetrating trauma
Penetrating trauma is an open wound injury that occurs when an object pierces the skin and enters a tissue of the body, creating a deep but relatively narrow entry wound. In contrast, a blunt or non-penetrating trauma may have some deep damage, but the overlying skin is not necessarily broken and the wound is still closed to the outside environment. The penetrating object may remain in the tissues, come back out the path it entered, or pass through the full thickness of the tissues and exit from another area.[1]
"Exit wound" redirects here. For other uses, see Exit wound (disambiguation).Penetrating trauma
A penetrating injury in which an object enters the body or a structure and passes all the way through an exit wound is called a perforating trauma, while the term penetrating trauma implies that the object does not perforate wholly through.[2] In gunshot wounds, perforating trauma is associated with an entrance wound and an often larger exit wound.
Penetrating trauma can be caused by a foreign object or by fragments of a broken bone. Usually occurring in violent crime or armed combat,[3] penetrating injuries are commonly caused by gunshots and stabbings.[4]
Penetrating trauma can be serious because it can damage internal organs and presents a risk of shock and infection. The severity of the injury varies widely depending on the body parts involved, the characteristics of the penetrating object, and the amount of energy transmitted to the tissues.[4] Assessment may involve X-rays or CT scans, and treatment may involve surgery, for example to repair damaged structures or to remove foreign objects. Following penetrating trauma, spinal motion restriction is associated with worse outcomes and therefore it should not be done routinely.[5]
Assessment and treatment[edit]
Assessment can be difficult because much of the damage is often internal and not visible.[4] The patient is thoroughly examined.[2] X-ray and CT scanning may be used to identify the type and location of potentially lethal injuries.[2] Sometimes before an X-ray is performed on a person with penetrating trauma from a projectile, a paper clip is taped over entry and exit wounds to show their location on the film.[2] The patient is given intravenous fluids to replace lost blood.[2] Surgery may be required; impaled objects are secured into place so that they do not move and cause further injury, and they are removed in an operating room.[2] If the location of the injury is not obvious, a surgical operation called an exploratory laparotomy may be required to look for internal damage to the organs in the abdomen.[17] Foreign bodies such as bullets may be removed, but they may also be left in place if the surgery necessary to get them out would cause more damage than would leaving them.[12] Wounds are debrided to remove tissue that cannot survive and other material that presents risk for infection.[2]
Negative pressure wound therapy is no more effective in preventing wound infection than standard care when used on open traumatic wounds.[18]