Puncture Wounds: Care Instructions | Kaiser Permanente

Skip Navigation

Overview

A puncture wound can happen anywhere on your body. These wounds tend to be narrower and deeper than cuts.

A puncture wound is usually left open instead of being closed. This is because a puncture wound can be easily infected, and closing it can make infection even more likely.

You will probably have a bandage over the wound.

The doctor has checked you carefully, but problems can develop later. If you notice any problems or new symptoms, get medical treatment right away.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

• Keep the wound dry for the first 24 to 48 hours. After this, you can shower if your doctor okays it. Pat the wound dry.
• Don’t soak the wound, such as in a bathtub. Your doctor will tell you when it’s safe to get the wound wet.
• If your doctor told you how to care for your wound, follow your doctor’s instructions. If you did not get instructions, follow this general advice:
  • After the first 24 to 48 hours, wash the wound with clean water 2 times a day. Don’t use hydrogen peroxide or alcohol, which can slow healing.
  • You may cover the wound with a thin layer of petroleum jelly, such as Vaseline, and a nonstick bandage.
  • Apply more petroleum jelly and replace the bandage as needed.
• Prop up the sore area on pillows anytime you sit or lie down during the next 3 days. Try to keep it above the level of your heart. This helps reduce swelling.
• Avoid any activity that could cause your wound to get worse.
• Be safe with medicines. Read and follow all instructions on the label.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

When should you call for help?

Call your doctor now or seek immediate medical care if:

• You have new pain, or your pain gets worse.
• The wound starts to bleed, and blood soaks through the bandage. Oozing small amounts of blood is normal.
• The skin near the wound is cold or pale or changes color.
• You have tingling, weakness, or numbness near the wound.
• You have trouble moving the area near the wound.
• You have symptoms of infection, such as:
  • Increased pain, swelling, warmth, or redness around the wound.
  • Red streaks leading from the wound.
  • Pus draining from the wound.
  • A fever.

Watch closely for changes in your health, and be sure to contact your doctor if:

• The cut reopens.
• You do not get better as expected.

Where can you learn more?

Go to https://www. healthwise.net/patientEd

Enter S876 in the search box to learn more about “Puncture Wounds: Care Instructions”.

Emergency Wound Management for Healthcare Professionals|Natural Disasters and Severe Weather

[NOTE: See also Emergency Wound Care After a Natural Disaster.]

The risk for injury during and after a natural disaster is high. Tetanus is a potential health threat for persons who sustain wound injuries. Tetanus is a serious, often fatal, toxic condition, but is virtually 100% preventable with vaccination. Any wound or rash has the potential for becoming infected and should be assessed by a health-care provider as soon as possible.

These principles can assist with wound management and aid in the prevention of amputations. In the wake of a flood disaster resources are limited. Following these basic wound management steps can help prevent further medical problems.

Evaluation

• Ensure that the scene is safe for you to approach the patient, and that if necessary; it is secured by the proper authorities (police, fire, civil defense) prior to patient evaluation.
• Observe universal precautions, when possible, while participating in all aspects of wound care.
• Obtain a focused history from the patient, and perform an appropriate examination to exclude additional injuries.

Treatment

• Apply direct pressure to any bleeding wound, to control hemorrhage. Tourniquets are rarely indicated since they may reduce tissue viability.
• Examine wounds for gross contamination, devitalized tissue, and foreign bodies.
• Remove constricting rings or other jewelry from injured body part.
• Cleanse the wound periphery with soap and sterile water or available solutions, and provide anesthetics and analgesia whenever possible.
• Irrigate wounds with saline solution using a large bore needle and syringe. If unavailable, bottled water is acceptable.
• Leave contaminated wounds, bites, and punctures open. Wounds that are sutured in an unsterile environment, or are not cleansed, irrigated, and debrided appropriately, are at high risk for infection due to contamination. Wounds that are not closed primarily because of high risk of infection should be considered for delayed primary closure by experienced medical staff using sterile technique.
• Remove devitalized tissue and foreign bodies prior to repair as they may increase the incidence of infection.
• Clip hair close to the wound, if necessary. Shaving of hair is not necessary, and may increase the chance of wound infection.
• Cover wounds with dry dressing; deeper wounds may require packing with saline soaked gauze and subsequent coverage with a dry bulky dressing.
• If wound infections develop, see “Guidance for Management of Wound Infections” (see below).
• Follow tetanus prophylaxis guidelines for all wounded patients.
• Follow tetanus prevention guidelines.

Other Considerations

• Be vigilant for the presence of other injuries in patients with any wounds.
• Ensure adequate referral, follow-ups, and reevaluations whenever possible.
• Dirty water and soil and sand can cause infection. Wounds can become contaminated by even very tiny amounts of dirt.
• Puncture wounds can carry bits of clothing and debris into wound resulting in infection.
• Crush injuries are more susceptible to infection than wounds from shearing forces.

Guidance for Management of Wound Infections

Most wound infections are due to staphylococci and streptococci. This would likely hold true even in the post-hurricane setting.

• For initial antimicrobial treatment of infected wounds, beta-lactam antibiotics with anti-staphylococcal activity (cephalexin, dicloxacillin, ampicillin/sulbactam etc.) and clindamycin are recommended options.
• Of note, recently an increasing number of community associated skin and soft tissue infections appear to be caused by methicillin-resistant Staphylococcus aureus (MRSA). Infections caused by this organism will not respond to treatment with beta-lactam antibiotics and should be considered in patients who fail to respond to this therapy. Treatment options for these community MRSA infections include trimethoprim-sulfamethoxazole (oral) or vancomycin (intravenous). Clindamycin is also a potential option, but not all isolates are susceptible.
• Incision and drainage of any subcutaneous collections of pus (abscesses) is also an important component of treating wound infections.

Special Considerations Related to Contamination of Wounds by Water

Contamination of wounds with water (fresh or sea water) can lead to infections caused by waterborne organisms. Though infections with these organisms are uncommon, even after floods, this possibility should be considered in patients who fail to respond to initial therapies described above. Water-borne organisms often implicated in these infections include: Aeromonas spp., non-cholera Vibrio spp. and sometimes Pseudomonas or other Gram-negative rods.

Trimethoprim/sulfamethoxazole, amoxicillin/clavulanate and newer fluoroquinolones (levofloxacin, moxifloxacin, gatifloxacin) will treat Aeromonas and the fluoroquinolones will also treat Pseudomonas and many other Gram-negative pathogens.

Clinicians should consider Vibrio as a possible causative organism of wound infections incurred in coastal waters or from contact with shellfish or marine wildlife. Vibrio vulnificus wound infections may require extensive debridement and mortality can be high. These infections often manifest with bullous lesions that may be hemorrhagic. Persons with underlying hepatic disease or other immunocompromising illness are at highest risk of Vibrio vulnificus infection. When this infection is suspected, the recommendation is that patients be treated with a combination of ceftazidime and doxycycline.

Stab wound – causes, symptoms, diagnosis and treatment

Stab wound is a tissue injury in which the depth of the wound channel exceeds the width of the inlet. It has even edges and is applied with a thin sharp object (awl, sharpening). Massive external bleeding from puncture wounds, as a rule, is absent, the condition in the initial stages often remains satisfactory, which can lead to an underestimation of the severity of the injury. The diagnosis is made on the basis of anamnesis and external examination data. If damage to internal organs is suspected, additional studies are required: chest x-ray, laparoscopy, etc. Operative treatment: PHO, suturing, dressings.

General information

Stab wound – a wound with even edges, a small inlet and a deep wound channel. Pure stab wounds are rare. In trauma practice, combined injuries are more often observed – stab wounds inflicted with a knife or dagger. The wound can penetrate into the natural cavities of the body (abdominal, thoracic, joint cavity), accompanied by damage to nerves, blood vessels and internal organs. Sometimes associated with TBI, bone fractures, closed chest injury, blunt abdominal trauma, and genitourinary system injuries.

Stab wound

Causes

Possible causes of a stab wound can be a criminal incident (shaving), an accident (falling on a pin), a traffic accident, industrial or natural disaster.

Pathogenesis

Features of damage depend on the location of the stab wound. It should be noted that such injuries should be treated with particular vigilance, not excluding severe injuries due to the small size of the inlet and the satisfactory condition of the patient. With wounds caused by sharpening, the depth of the wound channel can be 15-20 cm with an inlet size of only 1-2 cm. Wounds inflicted by an awl reach 8-10 cm in depth, and the length of the channel left by a metal pin cannot be predicted at all without PHO.

Injuries in the area of ​​neurovascular bundles may be accompanied by damage to vessels and nerves. At the same time, the absence of massive external bleeding does not exclude damage to the vessels, since after removing a sharp object, the tissues sometimes shift, clog the narrow wound channel, and the blood does not pour out, but into natural cavities or surrounding tissues.

The likelihood of damage to internal organs depends on the location. With a wound in the chest area, damage to the lungs and heart is possible, in the abdomen – damage to the liver, spleen, intestines, in the neck – damage to the trachea, larynx and esophagus, in the lumbar region – damage to the kidney, etc. It should be borne in mind that the possibility injury of one or another internal organ depends not only on the anatomical zone, but also on the direction and depth of the wound channel. So, with a stab wound of the abdomen, inflicted from the bottom up, damage can be observed not only to the liver, spleen or stomach, but also to the organs of the chest. And with a similar location of the inlet, but the wound channel directed from front to back, damage to the kidney is possible.

Another distinguishing feature of such wounds is the increased likelihood of wound infection. This feature is due to the fact that bacteria and contaminants that have penetrated into the wound cavity are poorly washed out by the blood and remain in the tissues. In addition, blood that has flowed not outward, but into the surrounding tissues, creates a favorable environment for the reproduction of microbes.

Classification

Taking into account the depth of penetration in traumatology and orthopedics, all wounds are divided into penetrating and blind. Taking into account the features that have a significant impact on the prognosis and treatment tactics, there are wounds without damage and with damage to internal organs. Taking into account the presence of local complications, wounds complicated by massive bleeding or partial prolapse of internal organs are distinguished.

Symptoms of a stab wound

Fresh wounds on the skin reveal a small wound hole, rounded with smooth edges. If a traumatic object (for example, a pin) remains in the wound, its edges are bent inward. Bleeding is usually minor. With stab wounds, the hole is slit-like or angular, the edges are even, one or both ends of the wound are sharp. Bleeding, as a rule, is not intense, but more blood is poured out than with stab wounds.

Other clinical manifestations depend on the localization of wounds, the presence or absence of damage to internal organs, nerves and blood vessels. A rapid increase in the volume of the damaged anatomical zone, combined with weakness, dizziness and fainting, indicates bleeding into the surrounding tissues, increasing shortness of breath in case of an injury in the chest area – lung damage, pneumothorax or hemothorax, weakness, shock phenomena and percussion dullness of sound in case of injuries to the abdomen – about possible damage to parenchymal organs (liver, spleen).

The edges of the infected wound are hyperemic, local hyperthermia is detected. Serous or purulent discharge is visible in the wound channel. Due to the development of infection in depth and poor outflow of contents, significant swelling of the surrounding soft tissues is often observed. Patients complain of intense jerking or throbbing pain. Symptoms of general intoxication are observed: fever, chills, weakness, fatigue, headaches.

Diagnosis

The diagnosis of stab wound is established on the basis of anamnesis and the results of an external examination. The volume of additional studies depends on the condition and complaints of the patient, the localization of the wound, the intended direction and depth of the wound channel. To assess blood loss, a complete blood count is done. If lung damage is suspected, a chest x-ray and a consultation with a thoracic surgeon are indicated; if damage to the abdominal organs is suspected, an abdominal surgeon’s consultation and laparoscopy (if there are sufficient grounds) are indicated. Suspicion of damage to a large vessel is the basis for a consultation with a vascular surgeon, suspicion of nerve damage – for a consultation with a neurosurgeon.

Treatment of a puncture wound

In the prehospital setting, if there is light bleeding, the skin around the wound should be washed and disinfected, followed by a sterile dressing. In case of massive bleeding, it is necessary to apply one of the methods for temporarily stopping bleeding (apply a tourniquet or pressure bandage, tamponade the wound). If a sharp object (pin, sharpening) remains in the wound, it should not be removed, as this can lead to increased bleeding and the development of shock. All patients with stab wounds are subject to immediate evacuation to a specialized medical facility.

Orthopedic traumatologists treat fresh stab wounds without damaging internal organs. Patients with suspected damage to internal organs, nerves and blood vessels are referred to the appropriate specialists: thoracic surgeons, abdominal surgeons, cardiac surgeons, urologists, vascular surgeons, neurosurgeons, etc. Treatment of infected stab wounds is carried out by surgeons.

In the presence of a fresh uncomplicated puncture wound, PST is indicated, which is usually performed under local anesthesia. The doctor flushes with solutions of peroxide and furacilin, examines the wound channel with a finger or probe, excise contaminated areas, if possible, and sutures the tissues in layers. To improve the outflow, stab wounds must be drained with half-tubes or rubber graduates. The drains are removed 1-3 days after the operation, the sutures are removed on the 8-10th day.

Patients with deep wounds, muscle damage and significant blood loss are subject to hospitalization in the trauma department. With minor soft tissue injuries, outpatient treatment in an emergency room is possible. In the postoperative period, UHF and antibiotic therapy are prescribed.

Damage to an internal organ is an indication for an appropriate abdominal operation. If the lung is injured, a thoracotomy is performed, if the abdominal organs are damaged, a laparotomy, etc. The doctor performs an audit, sutures the damaged organ and performs other therapeutic measures (the list of measures and tactics of surgical treatment depends on the characteristics of the wound). All patients with damage to internal organs are hospitalized.

Infected wounds are opened, washed and drained. Local treatment is carried out against the background of antibiotic therapy. First, broad-spectrum antibiotics are used, then the drug is prescribed taking into account the sensitivity of the detected microorganisms. Depending on the condition of the patient, treatment can be both inpatient and outpatient.

Prognosis and prevention

The prognosis for uncomplicated stab and stab wounds is more favorable than for lacerated and lacerated wounds. Relatively clean and even edges provide the best conditions for healing. However, the risk of infection with such wounds is higher than with shallow incised wounds. The outcome in complicated wounds depends on the characteristics of the injury (the severity of damage to certain organs, the volume of blood loss, the presence or absence of shock). Prevention includes measures to prevent injuries.

Stab wound – causes, symptoms, diagnosis and treatment

Stab wound is a tissue injury in which the depth of the wound channel exceeds the width of the inlet. It has even edges and is applied with a thin sharp object (awl, sharpening). Massive external bleeding from puncture wounds, as a rule, is absent, the condition in the initial stages often remains satisfactory, which can lead to an underestimation of the severity of the injury. The diagnosis is made on the basis of anamnesis and external examination data. If damage to internal organs is suspected, additional studies are required: chest x-ray, laparoscopy, etc. Operative treatment: PHO, suturing, dressings.

General information

Stab wound – a wound with even edges, a small inlet and a deep wound channel. Pure stab wounds are rare. In trauma practice, combined injuries are more often observed – stab wounds inflicted with a knife or dagger. The wound can penetrate into the natural cavities of the body (abdominal, thoracic, joint cavity), accompanied by damage to nerves, blood vessels and internal organs. Sometimes associated with TBI, bone fractures, closed chest injury, blunt abdominal trauma, and genitourinary system injuries.

Stab wound

Causes

Possible causes of a stab wound can be a criminal incident (shaving), an accident (falling on a pin), a traffic accident, industrial or natural disaster.

Pathogenesis

Features of damage depend on the location of the stab wound. It should be noted that such injuries should be treated with particular vigilance, not excluding severe injuries due to the small size of the inlet and the satisfactory condition of the patient. With wounds caused by sharpening, the depth of the wound channel can be 15-20 cm with an inlet size of only 1-2 cm. Wounds inflicted by an awl reach 8-10 cm in depth, and the length of the channel left by a metal pin cannot be predicted at all without PHO.

Injuries in the area of ​​neurovascular bundles may be accompanied by damage to vessels and nerves. At the same time, the absence of massive external bleeding does not exclude damage to the vessels, since after removing a sharp object, the tissues sometimes shift, clog the narrow wound channel, and the blood does not pour out, but into natural cavities or surrounding tissues.

The likelihood of damage to internal organs depends on the location. With a wound in the chest area, damage to the lungs and heart is possible, in the abdomen – damage to the liver, spleen, intestines, in the neck – damage to the trachea, larynx and esophagus, in the lumbar region – damage to the kidney, etc. It should be borne in mind that the possibility injury of one or another internal organ depends not only on the anatomical zone, but also on the direction and depth of the wound channel. So, with a stab wound of the abdomen, inflicted from the bottom up, damage can be observed not only to the liver, spleen or stomach, but also to the organs of the chest. And with a similar location of the inlet, but the wound channel directed from front to back, damage to the kidney is possible.

Another distinguishing feature of such wounds is the increased likelihood of wound infection. This feature is due to the fact that bacteria and contaminants that have penetrated into the wound cavity are poorly washed out by the blood and remain in the tissues. In addition, blood that has flowed not outward, but into the surrounding tissues, creates a favorable environment for the reproduction of microbes.

Classification

Taking into account the depth of penetration in traumatology and orthopedics, all wounds are divided into penetrating and blind. Taking into account the features that have a significant impact on the prognosis and treatment tactics, there are wounds without damage and with damage to internal organs. Taking into account the presence of local complications, wounds complicated by massive bleeding or partial prolapse of internal organs are distinguished.

Symptoms of a stab wound

Fresh wounds on the skin reveal a small wound hole, rounded with smooth edges. If a traumatic object (for example, a pin) remains in the wound, its edges are bent inward. Bleeding is usually minor. With stab wounds, the hole is slit-like or angular, the edges are even, one or both ends of the wound are sharp. Bleeding, as a rule, is not intense, but more blood is poured out than with stab wounds.

Other clinical manifestations depend on the localization of wounds, the presence or absence of damage to internal organs, nerves and blood vessels. A rapid increase in the volume of the damaged anatomical zone, combined with weakness, dizziness and fainting, indicates bleeding into the surrounding tissues, increasing shortness of breath in case of an injury in the chest area – lung damage, pneumothorax or hemothorax, weakness, shock phenomena and percussion dullness of sound in case of injuries to the abdomen – about possible damage to parenchymal organs (liver, spleen).

The edges of the infected wound are hyperemic, local hyperthermia is detected. Serous or purulent discharge is visible in the wound channel. Due to the development of infection in depth and poor outflow of contents, significant swelling of the surrounding soft tissues is often observed. Patients complain of intense jerking or throbbing pain. Symptoms of general intoxication are observed: fever, chills, weakness, fatigue, headaches.

Diagnosis

The diagnosis of stab wound is established on the basis of anamnesis and the results of an external examination. The volume of additional studies depends on the condition and complaints of the patient, the localization of the wound, the intended direction and depth of the wound channel. To assess blood loss, a complete blood count is done. If lung damage is suspected, a chest x-ray and a consultation with a thoracic surgeon are indicated; if damage to the abdominal organs is suspected, an abdominal surgeon’s consultation and laparoscopy (if there are sufficient grounds) are indicated. Suspicion of damage to a large vessel is the basis for a consultation with a vascular surgeon, suspicion of nerve damage – for a consultation with a neurosurgeon.

Treatment of a puncture wound

In the prehospital setting, if there is light bleeding, the skin around the wound should be washed and disinfected, followed by a sterile dressing. In case of massive bleeding, it is necessary to apply one of the methods for temporarily stopping bleeding (apply a tourniquet or pressure bandage, tamponade the wound). If a sharp object (pin, sharpening) remains in the wound, it should not be removed, as this can lead to increased bleeding and the development of shock. All patients with stab wounds are subject to immediate evacuation to a specialized medical facility.

Orthopedic traumatologists treat fresh stab wounds without damaging internal organs. Patients with suspected damage to internal organs, nerves and blood vessels are referred to the appropriate specialists: thoracic surgeons, abdominal surgeons, cardiac surgeons, urologists, vascular surgeons, neurosurgeons, etc. Treatment of infected stab wounds is carried out by surgeons.

In the presence of a fresh uncomplicated puncture wound, PST is indicated, which is usually performed under local anesthesia. The doctor flushes with solutions of peroxide and furacilin, examines the wound channel with a finger or probe, excise contaminated areas, if possible, and sutures the tissues in layers. To improve the outflow, stab wounds must be drained with half-tubes or rubber graduates. The drains are removed 1-3 days after the operation, the sutures are removed on the 8-10th day.

Patients with deep wounds, muscle damage and significant blood loss are subject to hospitalization in the trauma department. With minor soft tissue injuries, outpatient treatment in an emergency room is possible. In the postoperative period, UHF and antibiotic therapy are prescribed.

Damage to an internal organ is an indication for an appropriate abdominal operation. If the lung is injured, a thoracotomy is performed, if the abdominal organs are damaged, a laparotomy, etc. The doctor performs an audit, sutures the damaged organ and performs other therapeutic measures (the list of measures and tactics of surgical treatment depends on the characteristics of the wound). All patients with damage to internal organs are hospitalized.

Infected wounds are opened, washed and drained.