2026-07-21
A Plastic Surgeon's Classification of Wounds
Learn how plastic surgeons classify wounds based on depth and tissue layers, from superficial abrasions to deep injuries affecting the dermis and beyond.
Hello. Today's topic is wounds. We live our daily lives exposed to various environments. To maintain vital activities, our bodies effectively maintain defense mechanisms against external stimuli. Often, this system breaks down, and then undergoes a process of recovery. The breakdown is called a wound, the recovery process is called healing, and the stage after recovery is called a scar.
Today, I'd like to write about the first topic: wounds. There are various types of wounds that can occur on the skin. They can be classified according to the cause of external stimuli, such as scratches, lacerations, or burns, but I will classify them more professionally, layer by layer, starting from the skin.
If we classify our soft tissues layer by layer, from the outside to the inside, they are as follows: skin, subcutaneous fat layer, fascial layer, muscle layer, and bone layer. Thus, the body's layers can be broadly divided into these five layers. Among these, the skin and subcutaneous fat layer are the most common areas to be damaged in daily life. If the fascia or part of the muscle is damaged, it can cause significant functional problems.
The skin is subtly divided into two layers: the epidermis and the dermis. The epidermis consists of keratinocytes and primarily protects the body from the outside, performing various functions. It mainly produces keratin to maintain an appropriate moist environment. The dermis mainly contains fibroblasts that produce collagen, a fibrous tissue, and immune cells are distributed there, playing roles in maintaining skin elasticity and tension, and initial reception of immune responses. Also, sebaceous glands and sweat glands, which develop from the epidermis, are located there. Sebaceous glands and sweat glands form a shape where epidermal keratinocytes seem to have penetrated into the dermis, and these are called skin appendages. These are important because they become the origin of new epidermal cell generation for wound healing in areas affected by abrasions, burns, etc. This dermal layer is further divided into the papillary dermis and the reticular dermis. These are somewhat difficult terms, but the papillary dermis has finely developed capillaries and is the dermis closer to the epidermis, while the reticular dermis has more collagen fibroblasts and is a deeper dermal layer closer to the subcutaneous fat layer.
When a wound occurs, it can therefore be classified by depth. We distinguish between superficial wounds and deep wounds. A superficial wound (superficial injury) includes the epidermis and part of the dermis (mainly the papillary dermis), while a deep wound (deep injury) means damage not only to the epidermis but also to the entire dermis. The prognosis varies greatly depending on how much of the dermal layer is invaded, and naturally, the extent of the resulting scar also differs. In plastic surgery, we assess the extent of damage based on this depth and formulate a treatment plan based on science and evidence. It is more important to provide necessary treatment and management than to perform expensive laser or drug therapies.
Frequently Asked Questions
How are 'wound,' 'healing,' and 'scar' defined?
A wound signifies the breakdown of our body's defense system. Healing refers to the process of a wound recovering, and a scar designates the stage that remains after a wound has healed.
What layers make up the skin?
The skin is broadly composed of the epidermis and the dermis. The epidermis consists of keratinocytes and protects the outside, while the dermis contains collagen fibroblasts and immune cells, responsible for skin elasticity and immune responses.
What is the difference between a superficial wound and a deep wound?
A superficial wound (superficial injury) includes the epidermis and part of the dermis (mainly the papillary dermis). In contrast, a deep wound (deep injury) refers to damage not only to the epidermis but also to the entire dermis.
What are skin appendages and why are they important?
Skin appendages refer to the sebaceous glands and sweat glands that develop from the epidermis. They are important because they serve as the origin for the generation of new epidermal cells during wound healing from abrasions or burns.
How is wound treatment performed in plastic surgery?
In plastic surgery, the extent of damage is accurately assessed based on the wound's depth. Based on this, a treatment plan is formulated using scientific evidence, and necessary treatments and management are prioritized over expensive procedures.