Stephen J. Schueler, M.D.

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Puncture Wound Anatomy

To better understand a puncture wound, it helps to understand the anatomy of the skin.

The skin contains three main layers:

  • Epidermis:
    • The superficial layer that makes up the surface of the skin
    • It is composed of skin cells and can be divided into 5 layers based on cell type.
    • The top layer of the epidermis, the stratum corneum, is made of dead, flat skin cells that shed about every 2 weeks.
    • The thickness of the epidermis varies, according to location: it is very thick over the soles of the feet, and very thin over the ears.
  • Dermis:
    • Lies beneath the epidermis
    • Also varies in thickness depending on the location of the skin. It is .3 mm on the eyelid and 3.0 mm on the back.
    • The dermis is composed of 2 layers that contain a connective tissue called collagen
    • The dermis contains blood vessels, nerves, sweat glands, and hair follicles.
    • The number of structures in the dermis varies, according to location.
    • The dermis under the arms contains more sweat glands and hair follicles than the dermis on the back.
  • Subcutaneous layer:
    • Mainly fat and connective tissue.
    • Contains blood vessels and nerves.

Last Updated: Jan 3, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Puncture Wound References
  1. Baldwin G, Colbourne M. Puncture wounds. Pediatr Rev. 1999 Jan;20(1):21-3. [9919048]
  2. Harrison M, Thomas M. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Antibiotics after puncture wounds to the foot. Emerg Med J. 2002 Jan;19(1):49. [11777876]
  3. Haverstock BD, Grossman JP. Puncture wounds of the foot. Evaluation and treatment. Clin Podiatr Med Surg. 1999 Oct;16(4):583-96. [10553222]
  4. Laughlin TJ, Armstrong DG, Caporusso J, Lavery LA. Soft tissue and bone infections from puncture wounds in children. West J Med. 1997 Feb;166(2):126-8. [9109329]
  5. Lavery LA, Walker SC, Harkless LB, Felder-Johnson K. Infected puncture wounds in diabetic and nondiabetic adults. Diabetes Care. 1995 Dec;18(12):1588-91. [8722056]
  6. Weber EJ. Plantar puncture wounds: a survey to determine the incidence of infection. J Accid Emerg Med. 1996 Jul;13(4):274-7. [8832349]
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