Non-Intact Skin: WHO Definition, Classification, and Clinical Implications
Non-intact skin per WHO: any disruption of epidermal continuity from a break in the protective superficial layers (epidermis) or deeper (dermis/subcutis).
Classification by Depth
| Category | Depth | Examples |
|---|
| Superficial | Epidermis only | Abrasions, excoriations, superficial burns (1st degree), skin tears (Type 1) |
| Partial-thickness | Epidermis + part of dermis | Blisters, 2nd-degree burns, skin tears (Type 2), shallow lacerations |
| Full-thickness | Through dermis into subcutis | 3rd/4th degree burns, deep lacerations, surgical wounds, pressure injuries (Stage 3/4), necrotic ulcers |
Etiologic Categories
- Mechanical: friction, shear, pressure, trauma
- Thermal: burns, frostbite
- Chemical: irritants, caustics, chemotherapy extravasation
- Moisture-associated (MASD): incontinence, wound exudate, sweat
- Vascular: arterial/venous/lymphatic insufficiency ulcers
- Iatrogenic: surgical incisions, drain sites, device-related (MARSI)
Clinical Consequences
- Barrier loss → infection risk, fluid/electrolyte/protein loss, thermoregulation impairment
- Pain, pruritus, psychosocial impact
- Delayed healing → chronic wound (>4–6 weeks)
Documentation Essentials
- Location, dimensions (L×W×D), undermining, sinus tracts
- Wound bed: % necrotic, slough, granulation, epithelial
- Edge: attached, rolled, callused, erythema, induration
- Periwound: intact, edema, induration, cellulitis
- Exudate: amount, type, odor
- Photography with measurement scale
Infection Prevention
- Aseptic/clean technique per wound type
- Appropriate dressings (moisture balance, antimicrobial if indicated)
- Debridement of necrotic burden
- Systemic antibiotics only for spreading/systemic infection
Non-intact skin is a gateway; meticulous assessment and management prevent complications.
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