Skin Puncture Wound Anatomy
To better understand a puncture wound, it helps to understand the anatomy of the skin.
The skin contains three main layers:
- 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.
- 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.
- Baldwin G, Colbourne M. Puncture wounds. Pediatr Rev. 1999 Jan;20(1):21-3. 
- 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. 
- Haverstock BD, Grossman JP. Puncture wounds of the foot. Evaluation and treatment. Clin Podiatr Med Surg. 1999 Oct;16(4):583-96. 
- 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. 
- 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. 
- Weber EJ. Plantar puncture wounds: a survey to determine the incidence of infection. J Accid Emerg Med. 1996 Jul;13(4):274-7.