Wound Care Basics Dr. Charlie Booras, M.D.

by Charles H. Booras, MD


When to get help

Although most minor injuries can be handled at home...you should seek prompt medical care if:

  • You can't stop the bleeding. The first thing to do is apply pressure over the wound. Use sterile gauze if you have it, or a clean towel or shirt. The idea is not just to soak up blood but to apply firm pressure at the point where the bleeding is taking place. If the bleeding doesn't stop, be sure you are putting pressure on the correct spot. Ice and elevation of the bleeding extremity can slow the blood flow somewhat. If the bleeding is heavy or if it is still noticeable after fifteen to twenty minutes of pressure, you should seek medical help. If the bleeding stops, flush the wound with clean water and soap and inspect it carefully.
  • A cut is deep. Let's say, more than 1/8 to 1/4 inch. If the skin is cut all the way through the surface layer so that you see the full thickness of the skin, or the edges of the wound remain parted or can easily be pulled apart, or if fat, tendon, or muscle is visible.
  • A cut is longer than half an inch or in a place where potential scarring would be undesirable. Rough or jagged edges may also leave a scar.
  • Debris is embedded that you can't flush out. A good, thorough cleaning with soapy water is always the best strategy against infection.
  • There is loss of function. For example, the person can't bend or extend an injured finger.
  • An abrasion (skin is scraped from the surface but not cut through) is large (the size of the hand or larger) or deep.
  • A puncture wound is deep or caused by a nail or other dirty object or is located on a weight-bearing surface like the bottom of the foot.
  • A piece of penetrating object may still be in the wound.
  • A wound is on the face. Even a small cut on the face may leave a scar.
  • A wound was caused by an animal bite or scratch, or a human bite that breaks the skin. (A punch that lands on another's teeth and cuts the skin on the hand is known as a "fight bite.") These types of wounds are at high risk for the development of infection.
  • A puncture on the trunk or abdomen that is more than skin deep. An internal organ may have been penetrated.
  • It's been a long time since the last tetanus shot. Get a shot if it's been 5 years since the last shot and the wound is dirty or caused by an animal bite. In any case, if it's been 8-10 years since the last shot, get medical care.

Stitches

Stitches are sometimes important even when the wound isn't terribly serious in order to decrease scar formation and reduce the risk of infection in a wound that is open. The most important thing isn't usually stitches, but a careful cleaning and examination of the wound. Most wounds will heal without stitches, but if the injury isn't cleaned and examined for foreign material, infection is likely. Infection is the biggest danger with lacerations and other wounds.

Time is important in seeking medical care. A cut or injury that is 4 hours old before it's treated is significantly more likely to become infected than one that happened a half an hour ago. The longer you wait after the injury, the greater the possibility of infection.

In fact, after 8 hours, doctors usually won't use sutures to close a wound because of the chance they will be sealing in infection. Instead, the doctor will check the wound every few days for signs of infection.

If you decide you can take care of a wound yourself, you should follow good first aid practices:

  • Stop the bleeding. Use gauze or a clean cloth such as a handkerchief or washcloth--or, if nothing is available, your fingertips or hand will work--to apply pressure directly to the wound.
  • Clean and disinfect. Soon after the skin is broken, bacteria begin to multiply in the wound, so it's important to clean it thoroughly. Flush the injured area with running water and soap. Pick out any debris with sterile tweezers. This is especially important with abrasions that occur when the body meets the road as in a fall from a bicycle. The resulting grainy "road rash," with its characteristic little black particles, may provide an unwanted tattoo if it isn't thoroughly cleaned. If you are unable to clean the wound, seek medical assistance.

After cleaning the injury, apply an antimicrobial cream, ointment, or spray as an additional safeguard against infection. Don't use hydrogen peroxide, iodine, or alcohol directly in a wound because they may damage or irritate tissue; however, they are safe for cleaning wound edges and the skin around the injury.

Apply the ointment immediately after cleaning the site; if you wait too long, the wound will form a seal that the antiseptic can't penetrate. Contrary to popular belief, a dry, hard scab does not promote healing. A wound that remains moist heals faster. Also remember that a bandage or dressing is meant to protect the injury--not create an airtight seal. An airtight wound is more likely to become infected.

You don't want the wound either too moist or too dry. Change the bandage twice a day. Let the wound air dry for a half hour, then apply more ointment before putting on a clean bandage.

  • Abrasions. Abrasions should be covered with nonstick (Telfa style) gauze. Apply antiseptic cream and place or wrap the gauze loosely. It's important that the dressing not stick to the scrape. Most abrasions don't go through the skin, but when one does, it's obvious. If the wound looks more than surface deep and there is a very red and raw-looking quarter-sized patch, you should get help for it.
  • Small cuts. For small cuts, an adhesive bandage with a nonstick pad over the cut is adequate. Clean and dry the skin around the wound and be sure to touch only the adhesive and not the pad when applying it. Special shapes and bandages that can be cut to fit are available for knuckles, fingertips, and joints.
  • Don't use butterfly bandages or wound closure strips. If you bring the edges of a wound together with a butterfly bandage or other closure device but haven't cleaned it properly, you greatly increase the risk of infection.

Infection. Watch any cut or injury that has broken the skin for signs of infection. Even under ideal medical conditions, 5 percent of wounds become infected. Things to look for:

  • Increasing pain
  • Redness, swelling or heat
  • Pus or thick, greenish fluid
  • Red streaks under the skin extending from an injury in an extremity toward the body
  • Fever
  • If you note signs of infection, see a doctor. Antibiotics may be necessary to clear it up.

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