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CLINICAL MANAGEMENT OF
ACUTE SKIN TRAUMA
CLINICAL MANAGEMENT OF
ACUTE SKIN TRAUMA

JOEL W. BEAM
Designed cover image: Tinhouse Design

First published 2025

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ISBN: 9781638220664 (pbk)

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DOI: 10.1201/9781003523055

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 DEDICATION
To my parents, as your memories and spirit carry me daily.
To athletes, patients, students, and colleagues, thank you for the inspiration and support.
 CONTENTS
Dedication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Contributing Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv

Chapter 1 Clinical Presentation and Assessment . . . . . . . . . . . . . . . . . . . . . . . . .1

Chapter 2 Infection Control and Standard Precautions . . . . . . . . . . . . . . . . . . . . 15

Chapter 3 Cleansing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Bernadette Buckley, PhD, LAT, ATC

Chapter 4 Debridement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Chapter 5 Dressings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Chapter 6 Monitoring and Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Chapter 7 Infections and Adverse Reactions . . . . . . . . . . . . . . . . . . . . . . . . . 113

Mario Ciocca, MD

Chapter 8 Clinical Practice Scenarios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Appendix A: Wound Closure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Appendix B: Wound Care 101 Infographic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Appendix C: Clinical Application Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Financial Disclosures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
 ACKNOWLEDGMENTS
The development of a project such as this requires contributions of time, patience, expertise,
and effort from many individuals. The concept of the textbook began with a conversation with Brien
Cummings at SLACK Incorporated. I thank Brien for his vision and the opportunity to develop the
textbook. Also at SLACK, thanks to Kayla Whittle who came on board to see the project to comple-
tion. I extend special gratitude to the contributing authors, Bernadette Buckley, PhD, LAT, ATC and
Mario Ciocca, MD. Bernadette has been involved with me in the wound management journey from
the beginning, providing vision and support in the research and scholarly projects. Completion of
these projects would not have been possible without her assistance. Dr. Ciocca offered his knowledge
and clinical expertise in preparing the infections and adverse reactions chapter, essential components
in the management of acute skin trauma. The photographs and illustrations were made possible
through the efforts of local athletic trainers, contributing authors, and University of North Florida
Clinical and Applied Movement Sciences Department students and colleagues and the University
of North Florida Center for Instruction and Research Technology (CIRT). At CIRT, Shelby Scanlon
guided photo shoots, Brenna Smith created illustrations, and Andy Rush designed a web page for
photograph submission. I would like to thank each of them for their support. Special thanks to
Michael Boyles at CIRT for his creativity and proficiency in the final design of the photographs and
illustrations. These contributions play a significant role in the presentation of the chapters.
 ABOUT THE AUTHOR
Joel W. Beam, EdD, LAT, ATC is a professor and the chair of the Department of Clinical and
Applied Movement Sciences in the Brooks College of Health at the University of North Florida
(UNF) in Jacksonville, Florida. He also teaches within the Master of Science in Athletic Training
Program at UNF. His interest in athletic training began in junior high as a student athletic trainer
and continued through high school. Dr. Beam received his BS degree from East Carolina University
in Greenville, North Carolina; his MEd from Clemson University in Clemson, South Carolina; and
his EdD from UNF. He has 29 years of experience as an athletic trainer at the intercollegiate level
through positions at 4 universities. Dr. Beam has taught athletic training courses at the university
level for over 30 years and has held previous program director and clinical coordinator positions at
UNF. His research focuses on the effectiveness of occlusive dressings on healing rates of standard-
ized abrasions and the implementation of evidence-based acute skin trauma interventions into clini-
cal practice. He has authored book chapters and manuscripts and given numerous presentations at
international and national conferences and symposiums regarding acute skin trauma. Dr. Beam has
also authored the textbook Orthopedic Taping, Wrapping, Bracing, and Padding.
 CONTRIBUTING AUTHORS
Bernadette Buckley, PhD, LAT, ATC (Chapter 3)
University of North Florida
Jacksonville, Florida

Mario Ciocca, MD (Chapter 7)

University of North Carolina
Chapel Hill, North Carolina
 INTRODUCTION
Trauma and subsequent injury to the skin are frequent with participation in athletic, rec-
reational, and work activities. Various mechanisms of injury can produce abrasions, avulsions,
blisters, lacerations, punctures, and traumatic and postoperative incisions. Proper management
of these injuries is critical to creating an optimal environment to promote healing and lessen the
risk of infection and adverse reactions. Wound management techniques have evolved over the
last 60 years. However, ritualistic interventions and techniques continue in clinical practice today.
Techniques such as cleansing the wound daily with topical antiseptics, using dressings that promote
desiccation of the wound and formation of eschar, performing dressing changes without regard to
the progression of healing, and leaving attached necrotic tissue to the periwound tissue to protect
the wound can increase the risk of adverse reactions. During the 1960s, the discovery of a moist
wound environment with occlusion of the wound challenged many time-honored practices. These
investigations and other researchers examining cleansing, debridement, and dressing interventions
transformed the approach to the management of acute skin trauma.
The paradigm of evidence-based medicine guides appropriate management of acute skin
trauma, and implementation into clinical decision-making and practice can enhance the delivery
of health care services to patients. The overall goal of Clinical Management of Acute Skin Trauma
is to facilitate learning of the knowledge, skills, and clinical abilities required to manage acute
skin trauma effectively. The text is intended for professional athletic training students, practicing
athletic trainers, and other health care professionals responsible for acute wound care. Among stu-
dents, the text can first be used in the didactic setting and then taken to the clinical setting for skill
development. The material in the text covers the Board of Certification’s Practice Analysis and the
Commission on Accreditation of Athletic Training Education Curricular Content Standards related
to the management of acute skin trauma. Students should have a general knowledge of human and
skin anatomy, wound healing, and the assessment process to integrate the material in the chapters.
Interventions can be introduced and practiced in didactic labs with wound models to provide real-
world experiences. Among practicing athletic trainers and other health care professionals, the text
can serve as a practical resource guide for evidence-based practice. For others, the text introduces
evidence-based skin trauma management guidelines for implementation into current practice.
The chapters focus on individual components and interventions for the holistic management
of acute skin trauma. Chapter 1 provides information on the types, etiology, assessment, clinical
presentation, and initial management of acute skin trauma. Chapter 2 presents infection control
guidelines and techniques for facilities and management plans and recommended wound man-
agement supplies for facilities and kits. Chapter 3 includes cleansing, Chapter 4 debridement, and
Chapter 5 dressings for acute wounds. These chapters explain and illustrate evidence-based inter-
ventions and include the techniques’ goals and objectives, indications, contraindications, and proce-
dures. The selection and application factors to consider for patient management plans and summa-
ries of the evidence are also presented. Chapter 6 discusses patient monitoring and reassessment and
the role of patient education and adherence in the management plan. Chapter 7 explains the causes,
clinical features, treatment, and prevention of infection and adverse reactions. Chapter 8 includes
scenarios to allow students and clinicians the opportunity to bring together individual chapters,
interventions, and factors to develop and revise management plans for patients. Several appendices
are used to enhance the material for the reader. Appendix A presents an overview of wound closure
with sutures and staples. Common suture and staple techniques are illustrated. Appendix B contains
a wound care infographic that can be used for athlete, parent, and guardian education. Appendix C
includes a clinical application table summarizing cleansing, debridement, and dressing techniques
based on wound type. This table allows athletic training students and certified athletic trainers to
carry the guide in athletic training kits and bags in clinical practice settings.
xvi  Introduction

Clinical Management of Acute Skin Trauma will comprehensively guide the reader from the
initial injury assessment through complete wound healing using evidence-based practice techniques
for the management of acute skin trauma. Management considerations based on wound character-
istics; patient needs and activity levels; financial, physical, and personnel resources; various sports,
recreational, and work settings; and governing regulations will assist in the development of best-
practice, evidence-based clinical applications. The use of color photographs throughout the chapters,
step-by-step procedures of intervention techniques, and evidence summaries from the literature and
clinical expertise plays an integral role in enhancing the presentation and learning of the material.
 1
CLINICAL PRESENTATION
AND ASSESSMENT

Acute skin trauma can result in varying levels of damage to the epidermis, dermis, or subcuta-
neous tissues. These injuries can result in superficial insult to the epidermis with no effect on ath-
letic or work activities; other injuries may extend into the subcutaneous tissues and require referral
for advanced cleansing, debridement, and wound closure. Appropriate assessment of patients with
acute skin injury is critical to guide interventions, promote healing, and lessen the risk of complica-
tions. This chapter addresses the types, etiology, clinical presentation, assessment, clinical decision-­
making, and initial management of acute skin wounds.

ACUTE SKIN TRAUMA

The skin is the largest organ of the body and is composed of 3 layers: the epidermis, dermis,
and subcutaneous tissue (Figure 1-1). Skin functions to provide mechanical support, structure,
thermoregulation, and protection, serving as a physical barrier against trauma, external forces, and
microorganisms. It undergoes daily assault from shear and tensile loads and forces during athletic,
recreational, and work activities, often resulting in an open wound. Acute skin trauma is a disrup-
tion of the integrity of the epidermis, dermis, or subcutaneous tissues (or a combination of these

1 DOI: 10.1201/9781003523055-1
2  Chapter 1

Figure 1-1. The layers of

the skin.

layers).1 Disruption in the integrity of the epidermis, dermis, or subcutaneous tissues can com-
promise the protective functions of the skin and result in bacterial contamination, infection, and
the development of other adverse reactions. Acute wounds progress through an orderly reparative
process of inflammation, proliferation, and remodeling regardless of treatment, typically within 4
to 6 weeks, resulting in the restoration of anatomical and functional integrity.2-5 The inflammatory
stage initiates with platelet aggregation and the development of a fibrin clot followed by hemostasis.
An inflammatory response is produced to cleanse the wound and prepare an environment for tissue
repair. This response is characterized by erythema, swelling, warmth, and pain. The proliferation
stage begins within hours after injury and results in re-epithelization of the wound and the forma-
tion of a new extracellular matrix. The final remodeling stage begins around the second week of
healing and produces wound contraction, compaction, and strengthening. Healing tissues will
continue to remodel and strengthen over the next few months. Appropriate cleansing, debridement,
and dressing techniques can enhance the rates of healing and lessen the risk of adverse reactions.

TYPES OF ACUTE SKIN TRAUMA

The most common acute wounds include traumatic abrasions, avulsions, blisters, lacerations,
punctures, and traumatic and postoperative incisions. Acute skin trauma occurs through intentional
or unintentional external shear and tensile forces and tensile loads. Intentional trauma is a break or
tear in the skin during a surgical procedure (eg, a postoperative incision). Unintentional trauma is
a break or tear caused by an external, accidental mechanism (eg, a traumatic laceration). Trauma
and subsequent injury can result from a single or repeated exposure to forces and loads. The clinical
presentation is determined by the severity of the trauma and resultant tissue damage.1,6 Superficial-
thickness wounds involve injury to the superficial epidermis. Partial-thickness wounds extend
through the epidermis and into part of the superficial dermis, and full-thickness wounds extend
through the epidermis and dermis and into the subcutaneous adipose tissue.
Abrasions result from shear forces against a rough surface, typically in one direction.7,8 They
are common to the upper and lower extremities from contact with concrete, dirt, and artificial
playing surfaces. Abrasions present with capillary bleeding, erythema of the periwound tissue, and
possible contamination of the wound bed with debris (eg, sand, grass, dirt, or asphalt)8 (Figure 1-2).
Avulsions can result from tensile loads and result in skin and tissue failure.7,8 These wounds may
occur from violent contact with field or court structures (eg, a soccer goal) or protective equipment
(eg, a helmet). They present with partial or complete separation of skin and tissue from its normal
 Clinical Presentation and Assessment   3

Figure 1-2. An abrasion on

the anterior knee.

Figure 1-3. An avulsion on

the anterior lower leg.

anatomical structure, venous or arterial bleeding, trauma to underlying tissues and structures, and
contamination of skin and tissue flaps.7,8 Completely avulsed tissue with debris can also result7,8
(Figure 1-3). Blisters result from repeated unidirectional or multidirectional shear forces on moist
skin.8 These wounds are common to the feet and hands from contact with shoes and equipment.
Blisters present with a collection of extracellular fluid trapped between the epidermis and dermis at
the area of friction, erythema, and possible external hemorrhage and contamination.8 Closed blisters
4  Chapter 1

Figure 1-4. A closed blister

on the plantar forefoot.

Figure 1-5. An open blister

on the medial, posterior
calcaneus.

appear with a fluid-filled sac of varying size and erythema of the friction site and periwound tissue8
(Figure 1-4). Open blisters appear as an acute wound with a necrotic flap or roof of the skin attached
to the border of the drained sac, erythema of the periwound tissue, possible capillary bleeding, and
contamination with debris (Figure 1-5). The flap or roof of the skin can be removed entirely from
the blister margins at the assessment. Lacerations result from tension and shear forces, producing an
irregular tear in the skin and tissue.7,8 These wounds present with an irregular or jagged tear in the
skin, venous or arterial bleeding, possible trauma to underlying structures, and contamination with
debris8 (Figure 1-6). Punctures result from penetrating tensile forces and loads from a cylindrical,
sharp object.8 These wounds present as a tear or cavity in the skin, with a possible embedded object
in the wound, venous or arterial bleeding, possible trauma to the underlying structures, and con-
tamination with debris and foreign bodies (Figure 1-7). Incisions result from sharp tensile forces,
resulting in a clean tear in the skin.7,8 They present with a regular or clean tear in the skin, venous or
arterial bleeding, possible trauma to underlying structures, and contamination with debris8 (Figure
1-8). Incisions, lacerations, and punctures can also result from contact with improperly maintained
protective equipment (eg, exposed metal) and athletic structures (eg, bleachers and benches).
Clinical Presentation and Assessment   5

Figure 1-6. A laceration on

the upper lip.

Figure 1-7. A puncture on

the lateral lower leg caused
by a soccer training pole.
6  Chapter 1

Figure 1-8. An incision on

the palmar fifth finger.

ASSESSMENT
Assessment of skin trauma, like all acute injuries, is performed through primary and second-
ary surveys of the patient. The primary survey assesses the cardiovascular and respiratory systems,
head and cervical spine, profuse or uncontrolled bleeding, open or closed fractures, dislocations,
and nerve injury to identify emergent conditions and guide further assessment and appropri-
ate emergency treatment.9 Additional guidelines for a primary survey and emergency treatment
are described elsewhere. This section focuses on the secondary survey in the assessment of acute
wounds.
Assessment of skin trauma typically occurs directly after injury; however, some patients delay
seeking medical attention until athletic or work activity levels are affected by adverse reactions. The
assessment goals are to determine a clinical diagnosis, identify patient factors that may affect heal-
ing, and develop treatment interventions including possible referrals. In the athletic setting, imme-
diate postinjury assessments are often conducted on the field or court during practices and competi-
tions, including whether a patient can safely return to play in a timely manner. Documentation of
the assessment findings is critical for the clinical decision-making process and care of the patient.
Chapter 2 discusses infection control guidelines, environmental considerations, and supplies needed
for the assessment and management of acute skin trauma.
With most acute skin trauma injuries, the patient is ambulatory and conscious, and a secondary
survey can be performed without complications.7 The assessment is performed in a systematic or
overlapping manner based on the clinician’s knowledge of the patient. For example, access to and
knowledge of the patient’s prior medical history and records in the athletic setting can provide much
of this information. The secondary survey should include a history, inspection, palpation, muscle
and joint testing, neurologic and vascular assessments, and systems review as warranted.9 The his-
tory consists of open-ended questions of demographics, past medical history, and present injury his-
tory. Questions regarding age, occupation, activity level, lifestyle, previous injury to the area and past
treatment or surgery, occurrence of complications, and outcomes provide a baseline for treatment of
the current injury. For example, a patient working in a hot, humid warehouse will require a wound
dressing that will remain adherent in this environment. A patient traveling out of town for business
during the week may need a dressing that can remain on the wound bed for longer periods until the
next reassessment and education about dressing wear. A patient with a history of delayed healing
from previous wounds may benefit from a referral to determine the causative factor(s). Clinicians
should also obtain a health history of comorbid illnesses and conditions, current medications taken,
status of tetanus prophylaxis vaccination, and allergies to materials used to treat acute wounds to
 Clinical Presentation and Assessment   7

lessen the risk of adverse reactions. The use of anti-inflammatory medications may produce a delay
in healing. Sensitivity to topical antimicrobial creams and ointments, dressing adhesives, and occlu-
sion of the skin with dressings can also result in adverse reactions.
A history of the present injury includes the mechanism of injury, time of injury, location and
type of pain, presence of numbness or tingling, and sensations or sounds heard during the trauma
and can indicate the level of tissue damage and associated trauma.7 The mechanism and setting
(eg, an athletic field or automotive factory) of the injury can determine the extent of contamination
of the wound with debris and bacteria, tissue involvement, and possible associated trauma.4 For
example, a forearm abrasion sustained from sliding on a baseball dirt infield will likely be contami-
nated with small pieces of dirt and clay. A contusion to the forearm is also possible. The mechanism,
setting, and time of injury can also predict the level of bacteria in the wound and the potential for
infection.10 Wounds that are associated with fracture, visibly contaminated, or deep; wounds with
exposure of deep structures; wounds that are stellate or contain foreign debris; and delayed treat-
ment of wounds can increase the risk of infection. The type and location of pain associated with
acute wounds are commonly described as a stinging or sharp sensation localized to the damaged
tissue or body area. Pain radiating, referred, deep, or associated with movement can indicate second-
ary trauma to other structures, and further assessment is required. Documentation of pain levels
with visual analog or numeric rating scales can be performed. Numbness or tingling in an extremity
can indicate nerve pathology and associated trauma. Sensations and sounds can be associated with
fractures, strains, sprains, dislocations, and subluxations. In situations with delayed reporting of the
wound, clinicians should obtain past treatment from the patient. Clinicians should ask if cleansing,
debridement, or dressing interventions have been performed and what materials were used. The
patient should also be asked if the wound has changed since the injury. How has the initial pain
changed? How has the drainage from the wound changed? Has the wound bed dried and become
painful? The patient’s answers to these questions assist the clinician in determining which specific
techniques, if any, have been performed.
A bilateral inspection of the patient requires the assessment of the wound location, length,
width, and depth; the type and color of tissue in the wound bed; the type and amount of hemorrhage
or exudate; the condition of the periwound tissue; swelling and deformity of the surrounding soft
tissue; and the presence of debris in the wound.11,12 Irrigation of the wound bed and periwound tis-
sue with normal saline or potable tap water (without the presence of exposed bone or tendon)1 may
be required to identify tissue damage and the structures involved. The location, length, width, and
depth can indicate the extent of the trauma, the type of wound, and tissue damage. The wound loca-
tion, length, and width can impact the amount of skin tension and tissue approximation of the wound
and determine dressing and closure methods. Deep wounds with exposed bone, tendon, or ligament
structures should be referred for advanced cleansing, debridement, and closure.12 The measurement
of acute wounds through direct measurement, tracings, or photography is rarely performed based
on the predictable healing progression with appropriate management techniques. The wound bed
tissue type and color reveal the status of the wound and tissue viability (Table 1-1 and Figures 1-9
to 1-12). The immediate postinjury inspection typically reveals viable granulation tissue with vary-
ing amounts of contamination with debris. Based on the length of time from the injury, a delayed
inspection may reveal devitalized slough or eschar within the wound bed from a lack of or inappro-
priate treatment. External hemorrhage is common with acute wounds and is categorized as capillary,
venous, or arterial.7 Capillary bleeding produces oozing, bright red blood. Venous bleeding presents
as a steady flow of dark red blood. Arterial bleeding produces bright red blood in a squirting flow.
The production of exudate is generally related to the depth of tissue damage, with deeper wounds
presenting with higher levels of exudate than superficial wounds. Reassessments of exudate levels
can be influenced by dressing type and, in rare cases, infection. Erythema, maceration, denuded
tissue, ecchymosis, or swelling of the periwound or adjacent tissue can indicate infection, adverse
reactions, or trauma to secondary structures. For example, a delayed inspection of a heavily drain-
ing wound covered with a low-absorptive dressing can reveal maceration of the periwound tissue.
8  Chapter 1

Table 1-1. Wound Bed Tissue and Color13,14

Tissue Type Color Description
Granulation Red, pink Granular surface, moist, viable, healthy
(see Figure 1-9)
Slough, necrotic White, yellow, tan, brown, Devitalized, soft, moist, stringy or fibrous
(see Figure 1-10) green texture, loose or adhered to wound bed
Eschar, necrotic Black, brown Devitalized, desiccated, thick, hard or soft, loose
(see Figure 1-11) or adhered to wound bed or perimeter
Bone, tendon, White/gray (bone), white/ Viable, exposed, possible damage from trauma
ligament yellow (tendon and
(see Figure 1-12) ligament)
Color represents predominant color of the wound bed. Wounds may be multiple colors.

Figure 1-9. Granulation

tissue within the wound
bed.

Figure 1-10. Slough

within the wound bed.
(Reproduced with per­
mission from Irion G.
Comprehensive Wound
Management. 2nd ed.
SLACK Inc.)
 Clinical Presentation and Assessment   9

Figure 1-11. Eschar within

the wound bed.

Figure 1-12. Tendon

exposed within the wound
bed. Note the white
structure.

Excessive erythema can indicate infection or allergic contact dermatitis from a dressing. Debris (eg,
dirt, sand, or foreign bodies) in the wound bed can promote the development of infection.
Palpation of soft tissues for swelling, location of pain, temperature, and deformity can indi-
cate an associated injury or condition. Palpation is performed bilaterally, beginning away from the
injured site and finishing at the periwound tissue and wound. Avoid direct contact with the wound
surface and bed to prevent possible contamination and further trauma to the tissues. Swelling is
detected by a change in tissue density and can identify trauma to adjacent tissues or an underlying
10  Chapter 1

injury.9 Painful areas palpated away from the wound should be compared bilaterally and may
indicate an associated injury. Assessment of periwound tissue temperature is performed by lightly
touching the area with the dorsal surface of the hand and comparing it to the surrounding tissue to
determine relative differences. Elevated skin temperatures occur immediately after activity and may
also be associated with inflammation or infection. However, a decrease in temperature may signal
vascular pathology. A deformity in bony alignment, joint contour, or soft tissue deficit requires fur-
ther assessment and possible referral.
Range of motion and functional testing can indicate the readiness level of the patient to return
to activity or work and guide treatment interventions. Bilateral active range of motion of the joints
adjacent, distal, and proximal to the wound is first conducted when no associated injury or condition
is suspected. With normal results, resistive range of motion and functional testing are performed to
determine a return to activity. The inability of the patient to move the joint through a normal range
of motion warrants further assessment for possible associated trauma. Findings from the testing
may also impact dressing selection and application. For example, a patient with a partial-thickness
fingertip laceration will require a low-profile, durable dressing to allow full range of motion at the
distal interphalangeal joint to enter data successfully on a computer keyboard. Conversely, a patient
with a full-thickness anterior knee abrasion may experience a reduction in knee flexion with dress-
ing application, requiring a restriction in return to full activity.
Neurologic and vascular screenings are performed with deep wounds involving subcutaneous
tissue, bone, or tendon or nerve injury. The neurologic screen includes sensory, motor, and reflex
testing to identify nerve impingement, entrapment, or damage.9 Vascular screening is conducted
through the assessment of lower and upper extremity pulses distal to the wound and capillary refill
to determine the arterial blood supply.9
A review of systems is included as part of a complete assessment process. Evaluation of cardio-
pulmonary, respiratory, gastrointestinal, and genitourinary systems is necessary for patients with
deep wounds, comorbidities, a history of delayed wound healing or complications, or clinical fea-
tures of infection or adverse reactions. The review can identify factors that may affect wound heal-
ing; conditions that warrant referral for further evaluation and treatment; and cleansing, debride-
ment, and dressing interventions. Patients who return to athletic or work activities after assessment
and treatment interventions may not require a system review initially. Clinicians can review the
systems during reassessments as warranted.

CLINICAL DECISION-MAKING
Upon completion of the initial assessment, a clinical diagnosis and management plan are
determined based on the findings and individual patient. Findings will first determine if emergent
treatment and immediate referral are required. In some situations, a return-to-play decision will be
needed. The clinical diagnosis is based on patient signs and symptoms and wound characteristics
revealed in the primary and secondary surveys. The wound type is categorized by the depth and
extent of tissue involvement, tissue color, amount and type of hemorrhage, and associated trauma.
Wound categorization and assessment findings, such as a patient history of delayed healing or com-
plications, patient occupation or activity level, wound contamination and setting, and trauma to
other structures, guide the development of the management plan.
The management plan should include the types of interventions, frequency of reassessments,
patient education, prediction of time required for healing and return to activity, and outcome goals.
The type of wound determines the appropriate cleansing, debridement, and dressing interventions
needed to create an optimal environment for healing. For example, an open, partial-thickness blister
on a bony prominence may benefit from a thicker primary or secondary dressing to lessen friction
 Clinical Presentation and Assessment   11

forces and minimize further trauma to promote healing. A patient with a full-thickness incision over
an area of high skin tension without adequate tissue approximation requires emergent treatment and
referral. Reassessments should be conducted daily. The structured schedule in the athletic setting
normally allows for daily assessments in the athletic training facility. Education for patients on the
clinical features of infection and adverse reactions and guidelines for dressing wear can increase
adherence to daily monitoring and prevent unnecessary dressing changes.1 Most acute wounds will
follow a predictable sequence of repair and achieve complete healing within weeks.2,3 A safe return
to activity or work is allowed with a low risk of reinjury, full functional ability, and achieved objec-
tives of the intervention techniques. The goal of the management plan is to create a moist, clean,
and warm wound environment to facilitate complete healing in the shortest amount of time.1,15,16

INITIAL MANAGEMENT
Appropriate management of acute skin trauma involves prompt recognition and assessment of
the patient with immediate and follow-up interventions to promote healing and lessen the risk of
adverse reactions. After the primary and secondary surveys, immediate management of wounds in
the athletic setting is commonly performed on the field or court or in an athletic training facility.
This initial cleansing, debridement, and dressing of the wound to allow the patient a timely return to
activity must be followed after activity with a more comprehensive assessment in the athletic train-
ing facility.1 Daily monitoring and reassessments of the patient, wound bed, periwound tissue, and
dressing should be conducted to determine the effectiveness of the interventions, identify possible
development of adverse reactions, and guide dressing changes and revisions to the management
plan.
In some situations, referral of the patient with acute skin trauma or activation of the emergency
action plan is necessary. Organizations and institutions should develop and implement a written
emergency action plan that defines the personnel, equipment, communication system, emergency
transportation, location (eg, soccer practice field or aquatic center), emergency medical facilities,
and documentation procedures.17 If a referral is necessary after the assessment, thorough cleansing,
debridement, and dressing of the wound are not required. In these cases, promptly cover the wound
with sterile gauze, apply a secondary dressing, and refer. Immobilization of the body part should be
considered to prevent movement and lessen further trauma. Acute skin trauma injuries that require
referral are listed in Table 1-2.

SUMMARY
Acute skin trauma results from external shear and tensile forces and tensile loads and results in
various injuries to the skin. Assessment of skin trauma consists of primary and secondary surveys
to identify a clinical diagnosis, patient factors that may affect healing, and treatment interventions.
Clinicians perform the primary survey to identify emergent injuries and conditions. The clinician
assesses patient and wound history, inspects and palpates the involved and adjacent body areas,
evaluates readiness levels for activity, and reviews systems for associated trauma and conditions with
the secondary survey. The clinical presentation of acute wounds is based on the severity of trauma
and the resultant tissue damage. The clinician integrates the assessment findings to determine a
clinical diagnosis and develop a management plan for the patient and wound.
12  Chapter 1

Table 1-2. Acute Skin Trauma Requiring Referral1,7

Clinical features involving the following:
• Uncontrolled external hemorrhage
• Moderate loss of soft tissue
• Heavy, visible contamination
• Wounds associated with a fracture
• Animal or human bite
• Unsuccessful tissue approximation
• Unremovable embedded objects
• Lapse of tetanus immunization
• Deep wounds compromising subcutaneous tissue, tendon, or nerve
• Wounds that receive delayed treatment
• Patients with immunocompromised conditions
• Presence of numbness or tingling
• Wound infection: Fever, pain, edema, erythema, warmth, wound dehiscence, and delayed
wound healing
• Adverse reactions: Erythematous rash, eczematous reaction, vesicles, white discoloration,
tenderness, nodularity, burning, pruritus, or systemic reactions, including urticarial and
anaphylaxis

REFERENCES
1. Beam JW, Buckley B, Holcomb W, Ciocca M. National Athletic Trainers’ Association position
statement: Management of acute skin trauma. J Athl Train. 2016;51(12):1053-1070.
2. Lazarus GS, Cooper DM, Knighton DR, et al. Definitions and guidelines for assessment of
wounds and evaluation of healing. Arch Dermatol. 1994;130(4):489-493.
3. Lee CK, Hansen SL. Management of acute wounds. Surg Clin North Am. 2009;89(3):659-676.
4. Honsik KA, Romeo MW, Hawley CJ, Romeo SJ, Romeo JP. Sideline skin and wound care for
acute injuries. Curr Sports Med Rep. 2007;6(3):147-154.
5. Hussey M, Bagg M. Principles of wound closure. Oper Tech Sports Med. 2011;19:206-211.
6. Davidson JM. Animal models for wound repair. Arch Dermatol Res. 1998;290(suppl):S1-S11.
7. Miller MG, Berry DC. Recognition and management of soft tissue injuries. In: Miller MG,
Berry DC, eds. Emergency Response Management for Athletic Trainers. Wolters Kluwer/
Lippincott Williams and Wilkins; 2010:283-309.
8. Beam JW, Beck F. Soft-tissue injury management. In: Starkey C, ed. Athletic Training and
Sports Medicine: An Integrated Approach. 5th ed. Jones & Barlett Learning; 2012:13-36.
9. Starkey C, Ryan SD. Examination of Orthopedic & Athletic Injuries. 4th ed. F.A. Davis; 2015.
10. Franz MG, Steed DL, Robson MC. Optimizing healing of the acute wound by minimizing
complications. Curr Probl Surg. 2007;44(11):691-763.
11. Hess CT, Kirsner RS. Orchestrating wound healing: Assessing and preparing the wound bed.
Adv Skin Wound Care. 2003;16(5):246-257.
12. Nicks BA, Ayello EA, Woo K, Nitzki-George D, Sibbald RG. Acute wound management:
Revisiting the approach to assessment, irrigation, and closure considerations. Int J Emerg Med.
2010;3(4):399-407.
 Clinical Presentation and Assessment   13

13. Brown G. Wound documentation: Managing risk. Adv Skin Wound Care. 2006;19(3):155-165,
quiz 165-167.
14. Lampe, KE. The general evaluation. In: McCulloch, JM, Kloth, LC, eds. Wound Healing:
Evidence-Based Management. 4th ed. F.A. Davis; 2010:65-93.
15. Thomas S. A structured approach to the selection of dressings. World Wide Wounds. 1997.
Accessed June 25, 2021. http://www.worldwidewounds.com/1997/july/Thomas-Guide/Dress-
Select.html
16. Beam JW. Effects of occlusive dressings on healing of partial-thickness abrasions. Athl Train
Sports Health Care. 2012;4(2):58-66.
17. Anderson JC, Courson RW, Kleiner DM. National Athletic Trainers’ Association position
statement: Emergency planning in athletics. J Athl Train. 2002;37(1):99-104.
Exploring the Variety of Random
Documents with Different Content
Wells Cathedral, one of the co-founders, with her, of the Chantry at
Yeovil, which Alice Winford endowed with lands in Galhampton, Co.
Somerset, In a deed relating to Brimpton, and dated there on
Monday then next before St. Valentine's day, in 13 Henry VI., Alice
Winford is called Alice, sometime the wife of John Winford, and
cousin of Walter Veer, Esquire, whose deed it was and who directed
her, into whose custody he recited he had delivered a box with their
evidences therein under written, &c., to deliver same to John
Battiscombe, if the latter paid her /'20 in gold, which Walter Veer
might have in a good purse when he came to Brimpton again, and
for divers other causes for his Manor of Brimpton. John Battiscombe
purchased de Vere's estate, temp. Henry VI., in Co. Dorset, and
Alice, his wife, supposed to be identical with Alice Winford, although
there is no evidence to support it, is called daughter of Thomas
Beauchin.
 MASTER RICHARD STOURTON, RECTOR OF GILLIXGHAM.
9I b}' his and the testator's brother, Sir John Stourton, of Preston,
the precediui^^ day, as Morgan Googh, another executor, had
predeceased the testator. He is found in the deeds relating to Bishop
Bubwith's Almshouses in Wells, described as Master Richard
Stourton, clerk, and in the deed numbered 167, of 26th Jan., 1432,
he was party by that description with his nephew, Sir John Stourton,
knight, William Carent, and his brother, John Stourton, of Preston.
Master Richard Stourton sealed the deed with an Eagle displaced,
between four roundels or fountains, and the letters, R.S., but Mr.
Jewers wrongly described him as a younger son, instead of as uncle
of John, ist Lord Stourton. His death can be fixed somewhere about
the 13th May, 1437, on which date the next rector of Gillingham was
instituted on his death in his place. This was 1 1 years before the
barony of Stourton was created by patent. His aunt, Mary Stourton,
was a nun at Shaftesbury, and his sister, Margaret Stourton, was
Abbess there, having been confirmed and received the benediction,
9th December, 1423, and died 30th October, 1441. So she was
actually the Patroness of Gillingham during a portion of the time
Master Richard Stourton was rector there. His sister, Anastatia
Stourton, was, like her aunt, Mary Stourton, also a nun at
Shaftesbury. Under their names mention is made of the Stourton
arms having been found in the ruins ol Shaftesbury Abbey. See
under Sir William Stourton for Morgan Googh. iv. — Huskin Stourton
is neither mentioned in the old pedigree of 1509, Harleian
Manuscript 1074, Edmondson nor Collins, but only in Hoare's copy of
the College of Arms pedigree, and as having died sine prole. V. —
Edmund Stourton is not mentioned in any of the above pedigrees,
excepting in that of Collins, who says he died without issue. Possibly
Collins wrongly identified him, for he might really have been a son of
that John Stourton, who was son of Roger Stourton, Lord of
Horningsham. vi. — Edith Stourton, whom the Visitation for Co.
Beds, erroneously called daughter and heir of John, Lord Stourton,
although the Visitation for Co. York leaves his name in blank, but
from an inscription* it was recorded, *' Hie jacet Editha soror WiWi
Storton, quondam uxor' D'ni Joh'is Beauchamp, militis, et post uxor'
D'ni Roberti Shottesbroke, militis, qui obiit xiii. die Junii anno domini
1441!, cui' a'n'e p'pi'ef Deus." Edmondson '■■ Harl. MS. 1074. i Sir
John Stourton was not created a Baron until soven years afterwards.
 92 HISTORY OF THE NOBLE HOUSE OF STOURTON.
erroneously placed her as a child of her father's first marriage, but
Haare and Collins both mentioned her as part issue of the second
marriage. She and both her husbands were recorded in the Visitation
for Co. Beds., and in Harleian MS. 1074, a fuller account is given of
her, shewing the inscription to her first husband and that inscribed to
her own memory, wherein she was called sister of William Stourton,
sometime wife of Sir Thomas Beauchamp, knight, and after wife of
Sir Robert Shottesbroke, knight. Under her brother, John Stourton, of
Preston, it is seen that the heirs of the body of his sister, Edith,
called late wife of Sir Robert Shottesbroke, knight, had the next
remainder in certain of his property, contingent on his three
daughters dying without issue, which they did not do. She married
(i) Sir John Beauchamp, knight, of Bletsho, Co. Bedford, sometimes
called Lord Beauchamp, but he was never summoned to Parliament ;
he had livery of his lands in 1406-7, and died in 141 2, and (2) Sir
Robert Shottesbroke*, who was shewn to be the then husband of
Edith, late wife of John Beauchamp, chivalier, in an Inquisition taken
at Sherborne, Co. Dorset, on 30th April, 9 Henry V., after the death
of her only son, John, son and heir of John Beauchamp, relating to
the Manor of Ashmore in that county. It will have been seen that her
issue by her first husband. Sir John Beauchamp, of Bletsho, Co.
Bedford, was given in the old pedigree set out on page 74, as : —
Margaret Beauchamp, only daughter, but she had a brother, John
Beauchamp, Lord Beauchamp, only son and heir of his parents, who
succeeded his father when two years old, died 20th July, 8 Henry V.,
seised of the Manor of Ashmore, Co. Dorset, and other estates,
leaving the said Margaret, his sister and heir, then aged eleven years
and upwards, shewing that William Stourton, then deceased!, his
uncle, had been one of his trustees, and that Edith, his mother, was
then late wife of John Beauchamp, chivalier, and then wife of Sir
Robert Shottisbroke;}:. It is said by the Peerages that on his death
the right to any Barony created by the summons of 1363 would
devolve on his sister and next heir : — The said Margaret
Beauchamp, who married (1) Sir Oliver St. John, knight, of Bletsho,
in the County of Bedford, who died in 1437, having acquired on his
marriage the Lordship of Bletsho, Co. Beds., •= Visitation of Beds.,
Had. MS. 1074. f He had died in 1413. [ Inq. P.M., taken at
Sherborne, 30th April, g Hen. V.
 THE ROYAL HOUSE OF TUDOR. 9_; and Lydiard Tregoze,
Co. Wilts., and through her was ancestor oi' the Lords St. John, of
Bletsho, Co. Beds. ; the Barons St. John, of Lydiard Tregoze, Co.
Wilts., and Battersea, Co. Surrey ; Viscounts St. John, and Viscounts
Bolingbroke, Co. Lincoln ; the Earls of Bolingbroke ; and the
Baronets of Longthorpe, Co. Northampton; (2) John Beaufort, ist
Duke of Somerset, K.G., grandson of John of Gaunt, Duke of
Lancaster, and titular King of Castille and Leon, fourth son of King
Edward IIL ; his grace died 27th May, 1444, (the pedigree says
1446,) buried in Wimborne Minster, Co. Dorset, aged 39; and (3)
Leo, Lord Welles, K.G., who was slain at Towton, loth July, 1460. The
Visitations and other records shew she eventually became sole heir
of her father, and that she inherited Ashmore Manor, and other
premises there, dying seised of same 8th August, 22 Edward IV.,
leaving John St. John, Esquire, her son, by her first husband, who
was her next heir, then aged 40 years and upwards*, from whom
descended the Lords St. John, of Bletsho, Co. Beds., the Earls of
Bolingbroke, and the Baronets of Longthorpe, Co. Northampton. By
her second husband, John, ist Duke of Somerset, she had an only
daughter : — Lady Margaret Beaufort, who was sole child and
heiress of her father, and aged three years at his deathf. She was
borji at Bletsho in 1441, married (i) Edmund Tudor, Earl of Richmond
and premier Earl of England, half-brother to King Henry VL, and son
and heir of Sir Owen Tudor, knight, by Queen Catherine, his wife,
widow of King Henry V., and youngest daughter of King Charles VL
of France ; (2) Sir Henry Stafford, sometimes called Lord Henry
Stafford, a title by courtesy, as he was the younger son of
Humphrey, Duke of Buckingham, and a great-great-grandson of King
Edward HL, and cousin on both sides to his said wife, the Countess
of Richmond ; and (3) Thomas Stanley, Earl of Derby, Lord Stanley,
Lord of Man, and Great Lord High Constable of England, who placed
the Crown of England on the head of his stepson, Henry VH., at the
Battle of Bosworth Field. She died sine prole by her two last
husbands, but by her first husband, Edmund Tudor, Earl of
Richmond, was mother of an only son :— Inq. P M., taken at
Shaftesbury, 28th October following. Esch. 22 Henry VI.
 94 HISTORY OF THE NOBLE HOUSE OF STOURTON. King
Henry VII. of England, ancestor of the Royal House of Tudor which
ended in Queen Elizabeth ; and ancestor through his daughter,
Queen Margaret of Scotland, of James I., King of England*. Thus
from Henry VII. came all the Kings and Queens of England of the
Tudor Family, viz :^Henry VIII., Edward VI., and Queens Mary and
Elizabeth, besides Queen Margaret, consort of James IV. of Scotland,
from which queen descended Mary, the unfortunate Queen of Scots,
mother of James I., King of England, whose father was grandson of
the same Queen Margaret of Scotland, consequently Henry VII. was
ancestor of the Kings and Queens of the Royal Houses of Stuart and
of Hanover. The Countess of Richmond and Derby, King Henry VII's
mother, founded Christ's College (God's House) at Cambridge, and
her executors founded, after her death, the St. John College there,
and she is clearly shewn to have been sole heir of her father. She
made her relative, Sir John St. John, who was grandson of her
mother by Sir Oliver St. John, her chamberlain and an executor of
her will. Of her first marriage there is no dispute, and the obiiti
which by deed of 2nd March, 1505-6, she made between herself and
the Abbot, Prior, and Convent of Westminster, should leave no
reasonable doubt that she had three husbands, for she therein
ordered the Cantarists in their masses not only to pray for the souls
of herself, her parents, her son, Henry VII., his issue, and all her
progenitors and ancestors, but also for her three husbands, naming
them as Edmund, Earl of Richmond ; Thomas, Earl of Derby ; and
Henry, Lord Stafford;!:. The Duke of Buckingham confirmed the
marriage of his son, Sir Henry Stafford, by bequeathing 400 marks
to his said son, and Margaret, Countess of Richmond, his wife. The
Countess of Richmond made her will 6th June, 1508, proved 17th
October, 1512, * This is tlie pedigree spoken of by John Aubrey. f
Widmore says she obtained a license of mortmain for £150 per
annum, and conveyed /'go of it to the Convent of Westminster, for
the purpose of an anniversary for herself, for three monks to
celebrate mass in the Abbey church, and for the payment of the
salaries of the professors founded in the two universities, and her
Cambridge preacher. Her will and the Valor Eccksinsticiis shew her
land was charged for the above objects. The deed between her and
the Abbot of Westminster is preserved among the Lansdowne MSS. I
See the rather amusing wordy battle in " Vincent's Discoveries of
Errors in Brookes' Catalogue of Nobility," relating to the Countess'
marriage with Sir Henry Stafford, which Brookes alleged never took
place, but which Vincent shewed did, he quoting Patent 4th
December, 4 Edward IV., wherein is recited " Margarata; Comitissa:
Richmondiae uxori Henrici Stafford filij Humfridi nuper Ducis
Buckingha' per nomen Margaratas qus fuit uxor' Edmundi nuper
Comitis Richmond filia: et heredi Johannis [Beaufort] nuper Duci
Somerset."
 MARGARET STOURTON, ABBESS OF SHAFTESBURY. 95
which she prefaced " In the name of Ahnighty God, Anion. We,
Marg-aret. Countess of Richmond and Derby, moder to the most
excellent Prince King Henry the Vllth, &c." She died 29th June, 1509.
Her second husband made his will October 2nd, 147 1, proved May
4th, 1482, in which he described himself as " Harry Stafford, knig-ht,
son to the noble Prince Humphrey, late Duke of Bucks," and directed
his body to be buried in the Colleg-e of Plecye, he mentioned his
son-in-law, Henry, Earl of Richmond, afterwards Henry VH., giving
the residue of his goods to his beloved wife, Margaret, Countess of
Richmond, constituting her his executrix. The will of her third
husband was made 28th July, and proved 9th Nov., 1504, he
describing himself as "Thomas Stanley, Earl of Derby, Lord Stanley,
and Lord of Man, and Great Constable of England," he was created
Earl of Derby by Henry VH., having been Lord Steward of the
Household to Edward IV., dying at Latham in Lancaster, and being,
by his first wife, grandfather of the third Earl of Derby, whose
daughter married Charles, eighth Lord Stourton. vii. — Margaret
Stourton, Abbess of Shaftesbur)-, was confirmed and received the
Benediction, 9th December, 1423, and died 30th October, 1441. She
was succeeded by Edith Bonham, as Abbess, on the 15th November
following, and when, in 1817, John Dyneley, the proprietor of the
site of Shaftesbury Abbey, permitted Charles Bowles to make
searches, it was discovered that the floor of the Conventual Church
there, was composed of Roman tiles on which were the arms of
Stourton and Bonham in painted shields. viii.— Anastatia Stourton, a
Nun at Shaftesbury, who is mentioned in the will of her brother, John
Stourton, of Preston and Brimpton. She was living as a Nun at
Shaftesbury when Edith Bonham was elected Abbess thereof after
the death of her sister, Margaret Stourton, and was living in 1460,
when Margaret St. John was elected, as successor to Edith Bonham.
In 1861, the Wilts. Archaeological Association held a meeting in
Shaftesbury, when important excavations of about 80 feet square
were made in Shaftesbury Abbey. In what the Rev. J. J. Reynolds,
Rector of Holy Trinity, called King
 96 HISTORY OF THE NOBLE HOUSE OF STOURTON.
Edward's Chapel, the floor was found to have been paved with
Heraldic tiles of a later period, in very good order, laid in squares,
four similar shields of arms being placed together with a narrow
border of dark green. 2.— FITZ WARYN. 0©^ i p ^o^ LoL l> /^ V \
^^^ ^s ^^ 3. BRYAN. -UNAPPROPRIATED. -DENEBAUD. -
MONTACUTE. I. — The first four shields shew engravings of the
Stourton Arms. 2- — Hutchins (from whom this illustration is
reproduced) says these arms were assigned to Sir Fowke Fitz Waryn,
in a Roll temp. Edward II., as a knight of Dorset and Devon. 3. —
These arms he ascribed to the Bryans, of Woodsford, and he noticed
the marriage of Guyde Brian, with Elizabeth, daughter of William
Montacute, first Earl of Salisbury, and widow of Sir Hugh le
Despencer, knight. 4- — These arms he said were those oi de Clare,
Earls of Gloucester from about 1220 to 1350, he shewed they were
Lords of the Manor and Chase of Cranbourne, which extended to the
very precints of Shaftesbury. 5. — He gave as a cross between four
estoiles but was unable to appropriate the coat to anyone. 6. —
These he described as, on a chief a demi lion rampant, and ascribed
them to Denebaud, of Hinton St. George, Co. Somerset. 7. — These
he ascribed to Cheney of Brook, in Westbury, see pages 49-50. 8. —
These, he said, were the arms of Montacute, Earls of Salisbury from
1339 to 1448. In 1600, there were in the Crown Inn at
 ROYAL DESCENT FROM SIR JOHN STOURTON. Q7
Shaftesbury, the arms of Stourton, sable, a bend or, between six
roundels, or fountains proper, impaling" or three piles sable, point in
base, a canton ermine^ (Wrottesley)*. The Crown Inn was formerly
the residence of Mr. Tivinehow and must not be confused with the
King's Arms, in which the upper part of the old chimney piece
removed from Stourton House was placed. It was William, 5th Lord
Stourton, who married Thomasine, daughter of Sir Walter
Wrottesley, knight, aud these arms of Stourton, impaling those of
Wrottesley, were also to be seen formerly in the window of the south
aisle of Stourton Church. The Barons Stourton were mesne Lords of
Marston Bigott, holden of the Manor of Wanstre, Co. Somerset, and
on the 27th I'^eb., 1465, William Twynyho, Esq., and Ankaret, his
wife, had release of Daungen's tenement in Marston Bigot, under the
hand and seal of Robert Lambard, mesne Lord of the Manor called
Lambard's Court in Maiden Bradley, held under the Priory there|. He
was son and heir of John Lambard, of Donington and Maiden
Bradley, Co. Wilts., Esq., by Sibil, his wife, and kinsman and heir of
Alice, then late wife of Walter Hornby, of Maiden Bradley, gentleman,
through his mother, Sybil Lambard, and Alice Hornby§ ; they being
the daughters and coheirs of William Daungens, of Maiden Bradley,
and Lord of Little Langford, see page 35. This messuage
undoubtedly vested eventually in the Stourtons, as did the Priory
Manor of Maiden Bradley temp. Henry VI 1 1., when the heir of the
last holder by the Maiden Bradley Lamberts, was a minor on his
father's death. From the foregoing evidence we find Sir John
Stourton was ancestorof Ja'ia Seymour, 3rd consort of Henry VIII.
and mother of Edward VI., and also ancestor of Henry VI 1 1., and
consequently of all the descendants of Henry VII., as shewn by the
accompanying pedigree. Catherine, daiighter=S(> John Stourton,
Lord of Preston, Co.=Jaiu, daughter of of Henry, Lord , Somerset.
Called John, Lord Stourton in Ralph, Lord BasBeaumont, confirm- :
the Visitation of Beds., and Constable of set, confirmed by ed by
Hoare's copy i Corfe Castle ist March, 4 Richard IL Wit- Hoare's copy
of the of the College of 1 nessed Robert, Lord Fitz Payne's charter
College of Arms Arms pedigree and 1 of the Manor and Advowson of
Stourton, pedigree, by Edby Edmondson. Co. Wilts, 40 Edward II L
Described by mondson, and by j his son, John Stourton, of Preston,
as some- Brydges' Collins' ' time Lord of Stourton, Co. Wilts. Sheriff
Peerage, of Counties Dorset and Wilts., IJ77. Buried in the Abbey of
Stavordale, Co. Somerset. '■= Had. MS. 1427, fol. 196. f Held by Sir
William Stourton on the day he died in 1413, of Sir Thomas Lovell,
knight, and Willian Beauchamp, as of their Manor of Wanstre, by
unknown service. I History of Minster in Thanet, Co. Kent, (Aldred).
§ It is said she remarried John Bowles, of Bristol.
 98 HISTORY OF THE NOBLE HOUSE OF STOURTON. Sir
William Stourton, Lord= of Stourton, Co. Wilts., son and heir.
Speaker of the House of Commons. Steward of the Principality of
Wales. Died on Monday after the feast of St. Lambert, i Henry V,,
1413, and buried in the Priory of Witham, Co. Somerset. Will proved
22nd Sept., 1 411, Ad. cum Te^t. granted 23rd Sept.,
1413El!::abeth, dau. and coheir of Sir John Moygne, of Maddington,
Co. Wilts., and Estaines, Co. Essex, knight. Married 22 Richard II.
Buried with her husbaad in the Priory of Witham, Co. Somerset. Sir
John Stourton, created= Baron of Stourton, Co. Wilts. Lord and
Patron of Stourton. Sheriff of Co. Wilts., Sheriff of Co. Gloucester,
Treasurer of the Household. Served in the wars of France and
Normandy. Died on St. Catherine's day, 1462. Margery Wadham,
dau. of Sir John Wadham, of Merryfield, Co. Somerset, knight. The
Wadhams had long been connected with the Stourton family, see
under John Stourton, of Preston, Co. Somerset. Margaret Stourton,
who is=S(> George Darell, of Litshewn by Hoare, Ed- tie, Co. Wilts.,
knight, mondson and Collins as Keeper of the great warda daughter
of John, first robe to Edward IV. Lord Stourton, as well Sheriff of Co.
Wilts. 33 as by Harl. MS. 1074. Henry VI., and i, 5, and 9 Edward IV.
I Elizabeth Darell-- FiTst=yolm Seymour, who seated vife. Besides
her eldest son, she had a numerous family, her daughter, Margaret
Seymour, having married Sir Nicholas Wadham. himself at Wolihall,
Co. Wilts., aged 14 years in 1464, 4 Edward IV., at the death of his
grandfather. Edith Stourton. Both= Hoare and Collins call her part
issue by the second wife, but Edmondson alleged she was daughter
by the first wife. She married 2ndly Sir Robert Shottesbroke, knight.
Died 13th June, 1441. I Margaret Beauchamp, heir: of her father
and only brother. Widow of Sir Oliver St. John, of Bletsho, Co. Beds.,
who died in 1437. She married 3rdly Leo, Lord Welles, K.G., who was
slain at Towton, loth July, 1460. From her iirst n;iarriage descended
the Lords St. John, of Bletsho, Cq. Beds. ; the Barons St. Joljn, of
Lydiard Tregoze, Co. Wilts, and Battersea, Co. Surrey ; Viscounts St.
John and Bolingbroke, Co. Lincoln ; the Earls of Bolingbroke, and the
Baronets of Longthorpe, Co. Northampton. Sir John Beauchamp,
knight, of Bletsho, Co. Beds., son and heir of Sir Roger Beauchamp,
Chamberlain to Edward III. He was sometimes called Lord
Beauchamp, but he was never summoned to Parliament. Had livery
of his father's lands in 1406-7 and died in 1412. John Beaufort, Duke
of Somerset, K.G. descended from Edward III. Succeeded his
brother, Henry Beaufort, as 3rd Earl of Somerset in 1418. Created
Earl of Kendal and Duke of Somerset in 1442 by Henry VI. and died
1444, aged 39. Lady Margaret Beaufort,sole child and heir of her
father and a descendant of Edward III. Born at Bletsho in 1441, and
died 2gth June, 1509. She married (2) Sir Henry Stafford, son of
Humphrey, Duke of Buckingham, and (3) Thomas Stanley, Earl of
Derby, Lord Stanley and Lord of Man, Great Constable of England,
who placed the Crown on the head of Henry VII., at the battle of
Bosworth-field. Edmund Tudor, of Hadham, half-brother to Henry VI.
Eldest son of Sir Owen Tudor, knight, by Queen Catherine, his wife,
widow of Henry V., and youngest daughter of Charles VI., King of
France. Created Earl of Richmond, premier Earl of England, by Henry
VI., 1453, married July, 1455 and died 3rd Nov., 1456. From her
descended Anne Seymour, who married Dr. Edward Stourton, B.A.,
from Trinity College, Cambridge, 1649-50, M.A. 1653. He was a
licentiate of Medicine 1654, and was recorded as a doctor ?>VV^^
u'"V° ''?^°- ^' ''"^^ "°* *h'^ ^°"^ Seymour who married Sir
Thomas Hall, of Bradford, Co, Wilts., but her sister, Catherine
Seymour.
 ROYAL DESCENT FROM SIR JOHN STOL'RTON. Sir John
Sevmour, of= Wolthall. Succeeded his father in 1491, knighted 1496.
Made linightbanneret at siege of Touinay 15 13. Sheriff for Counties
Dorset, Somerset, and Wilts. Constable of Bristol Castle for life. Died
2ist Dec. [Sept.] '530, aged 60 years and 7 months. Buried in Easton
Priory Church, Co. Wilts., remains removed on dissolution and buned
30th Sept., 1590, ill chancel of Church at Great Bcdwin. Co. Wilts.
Margaret Wentworth, 2nd daughter of Sir Henry Wentworth, K.B., of
Nettlestead, Co. Suffolk, and Pontefract, Co. York, who died in 1 501,
seised of the Manors of Gedney, Goxhill, Chethani, Syberton,
Kynaston, &c. She died in 1550 and was buried with her husband in
the chancel of Great Eedwin Church. Henry VII., Kingof Eng-= land.
Dei Gratia Rex Ani^liieet Francice ct Domiiiiis Hibernuc. Born at
Pembroke Castle, 26tli July, 1455, proclaimed king after the battle of
Bosworth, 22nd Aug., 1485, crowned 30th Oct. following at
Westminster Abbey, married :8th Jan.. i486, died atRichmond, 2ist
April, 1309, and buried in his own chapel at Westminster. ; 99
Princess Elizabeth Plantagenet, eldest daughter and heir of Edward
IV., (born at Kouen, 29111 .April, 1441, proclaimed 4th March,
crowned 28th June, 1 46 1, married ist May, 1464, died at
Westminster, 9th April, 1483, buried at Windsor) by his royal consort,
Elizabeth, (who died 1492, widow of Sir John Grev, of Groby, who
fell at St. Albans, under the Lancastrian banner; and) daughter of Sir
Richard Wydeville, by Jacqueline (Jaquetta) of Luxemburg, his wife,
(widow ot John, Duke of Bedford, son of Henry IV., the celebrated
regent of France during the minority of Henry VI., and) daughter of
Peter, Comte de St. Paul. Jane Sevmotir, 3rd conSort.= Sister to
Edward, Duke of Somerset. Lord Protector, K.G.. executed by order
of his nephew, Edward VI., 1552. and sister to Thomas, Lord
Seymour, of Sudley, K.G., who married Queen Catherine, (Parr)
widow of Henry VIII. She married 20th May, 1556, and died in
childbed with her only child, !4th Oct., 1537. Buried in the Choir of
the Church within Windsor Castle, 1 Henry VIII. By the Grace of
God, King of England, France and Ireland, Defender of the Faith and
of the Church of England and of Ireland, on Earth the Supreme
Head. His Majesty was born at Greenwich, 28th Jan., 1491, crowned
24th June, 1509, died at Whitehall on his birthday, 28th Jan., 1547,
and buried at \Vindsor*. James IV., King= of Scotland, son of James
III., King of Scotland, by Margaret, his wife, daughter of Christian I.,
King of Denmark. Born 17th March, 1483, married 1503, and fell at
Flodden, 9th Sept., 1513, buried at Richmond in Surrey. I -Queen
Mar-garet Tudor, Eldest dau. Born 29th Nov.. 1489, her third
husband was Henry, Lord M e t h V e n. She was buried 1539 in the
Carthusian Church at Perth. ■■Archibald Dous;las, 6th Earl of Angus.
A \ery powerful nobleman, succeeded his grandfather 1514. His
second wife was Margaret, dau. of Robert, 5th Lord Maxwell. Died
1556. Edward VI., King of England, France and Ireland. Born at
Hampton Court, i2th Oct., 1537, crowned 25th Feb., 1547, died at
Greenwich, 6th July. 1553, unmarried, and buried at Westminster.
James V , King of Scot-= land. Born 15th April, 1512. His first wife
was Magdelene, (daughter of Francis I. of France, 1515-47, the most
distinguished of the kings there,) who died loth July, 1537, and was
buried at Holyrood. He died at Falkland 14th Dec, 1543 and buried
at Holyrood House. j =Mary o/Lo;-rai)i, daughter I of Claude, Duke
of Guise and dowager of Louis d'Orleans, Duke of LonI gueville. She
was regent of Scotland during her daughter's minority. Died in
Edinburgh Castle loth June, 1560, and buried at Kheims. Lady
Margaret Douglas, married Matthew Stuart, 4th Earl of Lennox, who
was one of the party for James III. of Scotland, who was slain in the
battle with his nobles. Regent of Scotland for his grandson, James
VI., during his minority, but in September, 1571, was basely
murdered at Stirhng.= 1/ Henry VIII., by his first wife, Catherine of
Arragon, daughter of Ferdinand V., King of Spain, and widow of his
brother, Arthur, Prince of Wales, was father of Queen Mary of
England; and by his second wife. Ann Boleyn, daughter of Sir
Thomas Boleyn, created Earl of Wiltshire and Ormonde, he was
father of Queen EHzabeth.
 HISTORY OF THE NOBLE HOUSE OF STOURTON. Francis
II., King of France.= Married when Dauphin of France, 24th April,
1558, died sine prole ^th December, 1560, aged 18 years. His
corpse was carried privately to St. Denis. When 16 years of age he
ascended the Throne of France on Henry II's death, 10th July, 1559.
zMary, Queen of Scots, only chi\d.-Born at Linlithgow, 7th Dec, 1542.
Imprisoned at Lochleven, abdicated 24th July, 1567, eventually
escaped from Lochleven to England, but recaptured and beheaded in
Fotheringhay Castle, 8th February, 1587. Henry Stuart, Lord Darnley,
Duke of Albany. King consort of Scotland. Heir male of the Stewards
of Scotland. Married 29th June, 1565, and according to Lodge 28th
July, 1564. Murdered at the Kirk of Field. loth February, 1567, by the
procurement of James Hepburn, Earl of Rothwell, Duke of Orkney,
who thereupon married Queen Mary of Scotland as her third
husband, on the 15th May, 1567, but by her died sine proleJames I.,
King of England, Ireland, Scotland, and France, Defender of the
Faith, &c. Born in Edinburgh Castle, 19th June, 1566, becoming King
of Scotland on his mother's abdication, and ascended the Throne of
England on Queen Elizabeth's death, 24th March, 1603. Crowned
King of England 25th July same year. Married 20th August, 1589,
Anne, (born 12th October, 1574, crowned in the Chapel of Holyrood-
house. 17th May, 1590, died 4th March, 1619,) dau. of Frederick II.,
King of Denmark. His Majesty died at Theobald's Park, Herts, 27th
March, 1625, and was buried at Westminster. John Aubrey speaks of
the Stourtons having- been ancestors of James. I., King of England.
John, 9th Lord Stourton, sat as one of the peers on the Trial of Mary,
Queen of Scots, an act which he ever afterwards regretted having
done. We now deal with : — Sir William Stourton, Lord of the Manor
of Stourton, Co. Wilts., son and heir of Sir John Stourton, of Preston,
Co. Somerset, and of Stourton, Co. Wilts., by Catherine, his wife,
daughter of Henry, Lord Beaumont, confirmed by Hoare's copy of
the College of Arms pedigree and by Edmondson. Collins placed him
as eldest son of Sir John Stourton, by his second wife, Jane,
daughter of Ralph, Lord Basset. Harleian MS. 1074 shewed him as
eldest son of John Stourton without giving his mother's name. John
Stourton, of Preston, senior, described himself in his will as brother
of William Stourton, son and heir of John Stourton, sometime Lord
of Stourton. In the inscription to Edith Stourton's memory she is
called '■'■ Editha Soror' WiWi Storfon.'" He appears to have been
one of her trustees of the Manor of Ashmore, Co. Dorset. Sir William
Dugdale started his pedigree of the Stourton family with this Sir
William Stourton, stating that the family was of great antiquity in
Wiltshire, taking its denomination from the town of Stourton, and it
from the river Stoure, on the bank whereof it was situated. He had a
remainder in his father's Preston Pluckenet property in contingent on
failure of issue of his father by Alice, his wife. tail 
 SIR WILLIAM STOURTON, OF STOURTON, CO. WILTS. lOI
In a manuscript book in the possession of Lord Mowbray, Segrave
and Stourton, at Allerton Park, Co. York, shewing the " Mannors and
Landes in the Coiintie of Somersett* /widen of the Right Honorable
the Lord Stourton and which wcare the possessions of the A
unccstors of tlie saied Lorde in the saide countic",\s a tracing
starting with this Sir William Stourton, as under : — " I Will'mus
Stowrton.mil'es, obijt Anno primol Henrici quinti et habit exit'. / I " 2
Joh'em, D'n'm Stowrton, qui obijt Anno) Secundo Edwardi Quarti et
habetexit'.)' Will'm, D'n'm Stowrton, qui obijt xviii ffebruariji Anno 17
Edwardi Quarti et habet exit'. J J, Anno primo Henry 7 et habet exit'.
Joh'em, D'n'm Stowrton, qui obijt vij Octrl J Fraunciscum, D'n'm
Stowrton}, qui obijt) infra etatum Anno 3. Henr' Septimi.J i Will'm,
D'n'm Stowrton, /ra^er pa Joli'is] D'm Stowrton, obijt 17 Febry Anno
150 1 Hen' 8. sine exit'. f I Edwardus, D'n's Stov/iion, frater pd
Will'Mi, D'ni Stowrton, obijt 24 Decembr' Anno 27 Hen' 8 et habit
exit'. I Will'm D'n'm Stowrton, qui obijt Anno 2\ Edwardi Sexti et
habet exit'. / I " 9 Carolum, D'n'm Stowrton, qui obijt Ann' 4( et 5
Phillippi et Marie et habet exit'. f I I " 10 Joh'em, D'n'm Stowrton, qui
obijt Anno 30 \ Eliz. Roe sine prole. ) "It Edwardus, D'n's Stowrton,
/ra/cr p
 I02 HISTORY OF THE NOBLE HOUSE OF STOURTON. " X2
Will'm modo D"n'm Stowrton, qui obijt 25° die Apr' Anno Dom' 1672,
et reliquit Will'mu' Do'nu' Stowrton ex Edwardo Stourton, ar', ffilio
primogenito diet! Gulielmi Dom'i Stowrton, defunct, qui quid Will'm,
D'n'm Stowrton, obijt ~'> die Aug' Anno 70 Jacobi s'c'di Regis et
reliquit Edward u', mode Dom' Stowrton Anno D'ni 1675," Sir William
Stourton, as shewn by the Inquisition taken after his death, held the
Manor and Advowson of Stourton, Co. Wilts., with two carucates of
land there, of Alice St. Maur, posthumous daughter and heir of Sir
Richard St. Maur, Lord St. Maur, and wife of Sir William Le Zouch, 5th
Lord Zouch, of Harringworth, the chief Lady, as of her honour of
Castle Cary, Co. Somerset. His other property in Stourton,
presumably part of the ancient demesnes, consisted of 9
messuages, 2 carucates of land, 10 acres of meadow, and 100 acres
of pasture. He is the first member of the family found holding the
Manor and Advowson, after the death of his ancestor. Sir Ralph
Stourton, who held them of the chief Lords of the same honour. It is
previously shewn that his grandfather. Sir William Stourton, was
seated at Stourton, and that the latter's son, Sir John Stourton,
witnessed a charter relating to the same Manor and Advowson.
Below we reproduce Sir Richard Colt Hoare's view of that Church in
Stourton, from the addenda following Vol. V. of his history of Wilts.
He does not appear to have presented to the church of St. Peter's, in
Stourton, as shewn in the account we give of the church and
patronage.
 SIR WILLIAM STOURTON, OF STOURTON, CO. WILTS. IO3
For during the period that Sir William Stourton held the Advowson
tlie Crown presented thereto, as well as partly during the minority of
Robert Poinings, son and heir of Isabella Poinings, who had died
holding the same, nth April, 17 Richard II., of the chief Lords, as of
the honour of Castle Cary, she being wife of Richard, Lord Poinings,
and daughter of Sir Robert Fitz Payne, alias de Grey, who likewise
held it with the Manor, and whose charter relating thereto. Sir John
Stourton had witnessed. The presentments by the Crown took effect
in 1396, 1398, 1403 and 1407. We have shewn from the pedigree on
pages 71 and 72, how he possibly descended from Maud
Badlesmere, the mesne Lady of Stourton, who had intermarried into
the Fitz Payne family, who held this Manorial estate of the chief
Lords, and it is proved by the pedigree on pages 43 and 44, that
through William, 2nd Lord Stourton (his grandson). Lord Mowbray,
Segrave and Stourton is one of the three coheirs to the Barony of
Fitz Payne, as being a descendant of Isabel Fitz Payne, daughter and
heir of Robert Fitz Payne, (son and heir of Robert Fitz Payne, Lord
Fitz Payne) and wife of Sir John Chidiock, of Westbury, Co. Wilts.,
ancestor of Margaret Chidiock. In the pedigree lastly above referred
to, it is found that William, 2nd Lord Stourton, became allied through
his wife, Margaret Chidiock, with the chief Lords of Stourton, as both
the above Margaret Chidiock and Alice St. Maur were descended
from Sir John St. Loe, whose daughters, (i) Joan, married Sir John
Chidiock, great-grandfather of Margaret Chidiock, and (2) Ela,
married Richard St. Maur, Lord St. Maur, grandfather o( Alice St.
Maur, Lady in chief of Stourton. Sir William Stourton married, 21
Richard II., Elizabeth, daughter and coheir of Sir John Moyne, of
Maddington, Co. Wilts., Buckhorn Weston, Co. Dorset, and Estaine,
Co. Essex, knight*, Lardiner at the Coronation of Henry V. Testa de
Nevile stated in effect that the Manor of Owre Moyne was held by
Ralph Moyne, of the Lord the King, by serjeanty of his kitchen, as his
ancestors had done from the time of Henry L, and also by serjeanty
of purveying that which belonged to the kitchen of the Lord the
Kingt. Sir John Moigne claimed to hold the Manors of Ogres or
Owres, Co. Dorset, Maddington, Co. Wilts., and Eyston, Co. Essex,
per les services d'estre achateur del kuysine de Roy et Lardiner de
Roy a temps de coronements de Royes et de Reynes d'Engliter Jacob
=■■ Patent 21 Richard II., part 3, mem. 7. f Ralph le Moigne or
Moien held this Manor, per servicium serjeantcie de coquina dono
itidem Ke^is Henrici primi.
 r04 HISTORY OF THE NOBLE HOUSE OF STOURTON. II.
This serjeantcie was admitted on the claim of Lord Maynard of
Estalnes, (of Easton, Co. Essex, as connected with Maddington, &c.,
Co. Wilts. Sir Henry Maynard, knight, secretary to the Lord Treasurer
of Burghley, purchased the Manor and Advowson of Great Easton,
from Oliver Cromwell, who was nephew and next heir of Richard
Warren, son and heir of Sir Ralph Warren, Lord Mayor of London,
who had purchased the Manor and Advowson from William, 7th Lord
Stourton, In 8 Edward II. it was found that Henricus le Moigne held
the Manor of Over Moigne, Co. Dorset, of the king in chief, p'
servic'm essendi Lardinar' dom' regis. William de Moyne held one
carucate in WinterbournMaddington in chief of the king per s'jant'
scil't ad emend' lardar' D'ni Regis, Edward III. Sir Ralph Warren held
the Manor of Great Easton by the serjeancy of being the king's
Lardiner and Purveyor of his kitchen on the coronation. It appears
that the reversion of the Manor of Owre Moyne vested in the Crown
until 7 George II. Canon Jackson said that by fortunate marriages,
first with the heir of Moyne, and afterwards with the heir of
Chidiock, the Stourtons obtained large possessions in Counties
Gloucester, Wilts., Somerset, and Dorset, and he should have said in
Co. Essex also. In Harleian Manuscript 1074, we find that in the
margin of the Stourton pedigree there recorded, two shields, the one
quarterly, ist and 4th, Sable, a bend or, between six fountains wavy
argent and azure, Stourton ; 2nd, or, a cross engrailed sable, Mohun
; and 3rd, Gules, an escutcheon within an orle of martlets argent,
Chidiock, The other shield is Argent^ two bars and in chief three
mullets sable, over which is written, " Wylliam Moyne". But Hutchins
said the Lords Stourton had no right to quarter the Mohun arms,
which were distinct from those of Moyne. He, — quoting jointly from
Camden and Coker — placed the arms of Moyne as Barry of six or,
and vert, as evidenced from many impressions found on old seals ;
Avhile in Owre Moyne Church and elsewhere, these arms were
shewn in the windows, their crest being a denii monk, with a
penitential whip in his hand. In the above pedigree it is entered that
"William Stourton, eldest son of John Stourton, married Elizabeth,
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