Puncture Wounds – Foot Health Facts

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What Is a Puncture Wound?

Puncture wounds are not the same as cuts. A puncture wound has a small entry hole caused by a pointed object, such as a nail that you have stepped on. In contrast, a cut is an open wound that produces a long tear in the skin. Puncture wounds require different treatment from cuts because these small holes in the skin can disguise serious injury.

Puncture wounds are common in the foot, especially in warm weather when people go barefoot. But even though they occur frequently, puncture wounds of the foot are often inadequately treated. If not properly treated, infection or other complications can develop.

Proper treatment within the first 24 hours is especially important with puncture wounds because they carry the danger of embedding the piercing object (foreign body) under the skin. Research shows that complications can be prevented if the patient seeks professional treatment right away.

Foreign Bodies in Puncture Wounds

A variety of foreign bodies can become embedded in a puncture wound. Nails, glass, toothpicks, sewing needles, insulin needles and seashells are some common ones. In addition, pieces of your own skin, sock and shoe can be forced into the wound during a puncture, along with dirt and debris from the object. All puncture wounds are dirty wounds because they involve penetration of an object that is not sterile. Anything that remains in the wound increases your chance of developing other problems, either in the near future or later.

Severity of Wounds

There are different ways of determining the severity of a puncture wound. Depth of the wound is one way to evaluate it. The deeper the puncture, the more likely it is that complications, such as infection, will develop. Many patients cannot judge how far their puncture extends into the foot. Therefore, if you have stepped on something and the skin was penetrated, seek treatment as soon as possible.

The type and cleanliness of the penetrating object also determine the severity of the wound. Larger or longer objects can penetrate deeper into the tissues, possibly causing more damage. The dirtier an object, such as a rusty nail, the more dirt and debris are dragged into the wound, increasing the chance of infection.

Another thing that can determine wound severity is if you were wearing socks and shoes, particles of which can get trapped in the wound.

Treatment

A puncture wound must be cleaned properly and monitored throughout the healing process to avoid complications.

Even if you have gone to an emergency room for immediate treatment of your puncture wound, see a foot and ankle surgeon for a thorough cleaning and careful follow-up. The sooner you do this, the better—within 24 hours after injury, if possible.

The surgeon will make sure the wound is properly cleaned and no foreign body remains. He or she may numb the area, thoroughly clean inside and outside the wound, and monitor your progress. In some cases, x-rays may be ordered to determine whether something remains in the wound or if bone damage has occurred. Antibiotics may be prescribed if necessary.

Avoiding Complications

Follow the foot and ankle surgeon’s instructions for care of the wound to prevent complications (see “Puncture Wounds: What You Should Do” further down on this page).

• Infection is a common complication of puncture wounds that can lead to serious consequences.
• Sometimes a minor skin infection evolves into a bone or joint infection, so you should look for these signs:
  • A minor skin infection may develop two to five days after injury.
  • The signs of a minor infection that show up around the wound include soreness, redness and possibly drainage, swelling and warmth. You may also develop a fever.
  • If these signs have not improved, or if they reappear in 10 to 14 days, a serious infection in the joint or bone may have developed.

• Other complications that may arise from inadequate treatment of puncture wounds include painful scarring in the area of the wound or a hard cyst where the foreign body has remained in the wound.
• Although the complications of puncture wounds can be quite serious, early and proper treatment can play a crucial role in preventing them.

Puncture Wounds: What You Should Do

• Seek treatment right away.
• Get a tetanus shot if needed (usually every 10 years).
• See a foot and ankle surgeon within 24 hours.
• Follow your doctor’s instructions.
• Keep your dressing dry.
• Keep weight off of the injured foot.
• Finish all your antibiotics (if prescribed).
• Take your temperature regularly. Watch for signs of infection (pain, redness, swelling, fever). Call your doctor if these signs appear.

Puncture Wound: Foot

A puncture wound occurs when a pointed object (such as a nail) pushes into the skin. It may go into the tissues below the skin of the foot, including fat and muscle. This type of wound is narrow and deep. They can be hard to clean. Puncture wounds are at high risk for becoming infected. One type of serious infection is more likely if you were wearing a rubber-soled shoe at the time of injury. Bacteria from the sole of the shoe may be dragged into the wound. Symptoms of infection may appear as late as 2 to 3 weeks after the injury. Be sure to watch for symptoms of infection and call your healthcare provider right away if any them appear.

X-rays may be done to see whether any objects remain under the skin. Your may also need a tetanus shot. This is given if you are not up-to-date on this vaccination and the object that caused the wound may lead to tetanus.

Puncture wounds can easily become infected. 

Home care

• When you sit or lie down, raise the foot above the level of your heart. This helps reduce swelling and pain.

• Don’t put weight on the injured foot if it hurts to do so or if you were told to keep weight off the injury.

• Your healthcare provider may prescribe an antibiotic. This is to help prevent infection. Follow all instructions for taking this medicine. Take the medicine every day until it is gone or you are told to stop. You should not have any left over.

• The healthcare provider may prescribe medicines for pain. Follow instructions for taking them.

• You can take acetaminophen or ibuprofen for pain, unless you were given a different pain medicine to use. 

• Follow the healthcare provider’s instructions on how to care for the wound.

• Keep the wound clean and dry. Don’t get the wound wet until you are told it is OK to do so. If the area gets wet, gently pat it dry with a clean cloth. Replace the wet bandage with a dry one.

• If a bandage was applied and it becomes wet or dirty, replace it. Otherwise, leave it in place for the first 24 hours.

• Once you can get the wound wet, you may shower as usual but don’t soak the wound in water (no tub baths or swimming)

• Check the wound daily for symptoms of infection. These include:

  • Increasing redness or swelling around the wound

  • Increased warmth of the wound

  • Worsening pain

  • Red streaking lines away from the wound

  • Draining pus

Follow-up care

Follow up with your healthcare provider, or as advised. 

When to seek medical advice

Call your healthcare provider right away if any of these occur:

• Any symptoms of infection (listed above)

• Fever of 100.4°F (38.ºC) or higher, or as directed by your healthcare provider

• Wound changes colors

• Numbness around the wound

• Decreased movement around the injured area

Puncture Wound | Advocare Family Medicine Associates

Is this your symptom?

• Skin is punctured by a narrow sharp object (a nail, pencil, toothpick)

Some Basics…

• Punctures are a type of skin wound made by a narrow sharp object.
• Puncture wounds can become infected, so need proper care.
• A tetanus shot is often needed after a puncture wound.

Types of Puncture Wounds

• Needlestick: if the wound is from a used or discarded needle, call a doctor right away. In some cases, medicines need to be started to stop the spread of infections like HIV/AIDS or hepatitis.
• Foot Punctures: punctures into the bottom of the foot have a 4% risk of infection. This risk is higher in people with puncture wounds that go through a shoe. Pain lasting 4-5 days after the injury may be a sign of infection.
• Pencil Lead Punctures: pencil lead is made of graphite, which is harmless. Pencils are not made of poisonous lead. Colored lead pencils are also nontoxic. However, the graphite will cause a long-lasting skin mark if it is not scrubbed out.

When to Call for Puncture Wound

Care Advice for Minor Puncture Wound

1. What You Should Know:
   • Punctures are a type of skin wound made by a narrow sharp object.
   • Puncture wounds can become infected, so need proper care.
   • You can treat minor puncture wounds at home.
   • Here is some care advice that should help.

2. Cleansing: Wash the wound with soap and warm water for 15 minutes. Scrub the wound with a washcloth to remove any dirt.

3. Antibiotic Ointment: Put on an antibiotic ointment covered with an adhesive bandage (Band-Aid) to reduce the risk of infection. Re-soak the area and put on more antibiotic ointment every 12 hours for 2 days.

4. Pain Medicine:
   • You can take one of the following drugs if you have pain: acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve).
   • They are over-the-counter (OTC) pain drugs. You can buy them at the drugstore.
   • Use the lowest amount of a drug that makes your pain feel better.
   • Acetaminophen is safer than ibuprofen or naproxen in people over 65 years old.
   • Read the instructions and warnings on the package insert for all medicines you take.

5. Expected Course: Puncture wounds seal over in 1-2 hours. Pain should get better within 2 days.

6. Call Your Doctor If:
   • Dirt in the wound is still there after 15 minutes of scrubbing
   • It begins to look infected (redness, red streaks, pus, or tender to touch)
   • Fever
   • Pain becomes severe or is not gone after 3 days
   • You think you need to be seen
   • You get worse

And remember, contact your doctor if you develop any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Puncture Wounds | Cigna

Do you have a puncture wound?

This is a wound caused by a sharp, pointed object going through the skin. Puncture wounds are deeper and narrower than cuts.

How old are you?

Less than 12 years

Less than 12 years

12 years or older

12 years or older

Are you male or female?

Why do we ask this question?

• If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
• If your symptoms aren’t related to those organs, you can choose the gender you identify with.
• If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.

Do you have an eye injury?

Do you have an injury caused by a fishhook?

Do you have a deep wound in your head, neck, chest, or belly?

A deep puncture wound in any of these areas could damage the internal organs.

Yes

Deep puncture wound to head, neck, chest, or belly

No

Deep puncture wound to head, neck, chest, or belly

Are you having trouble breathing (more than a stuffy nose)?

Yes

Difficulty breathing more than a stuffy nose

No

Difficulty breathing more than a stuffy nose

Has the pain lasted for more than 8 hours?

Yes

Pain for more than 8 hours

No

Pain for more than 8 hours

Is the pain getting worse?

Yes

Pain is getting worse

Have you been injected with something under high pressure, like oil or paint from a sprayer?

Yes

Injection under high pressure

No

Injection under high pressure

Is there a deep puncture in or over a joint?

A puncture that goes into a joint can be serious.

Yes

Deep puncture in joint area

No

Deep puncture in joint area

Do you have a wound on your arm, leg, hand, or foot that is more than just a scratch?

For an arm or leg wound, is the skin below the wound (farther down the limb) blue, pale, or cold to the touch and different from the other arm or leg?

This may mean that a major blood vessel was damaged and that blood is not reaching the rest of the arm or leg.

Yes

Skin is blue, pale, or cold below an arm or leg injury

No

Skin is blue, pale, or cold below an arm or leg injury

Can you move the area below the injury normally, even though it may hurt?

Yes

Able to move limb normally below injury

No

Unable to move limb normally below injury

For an arm or leg wound, is there any numbness, tingling, or loss of feeling around the wound or below the wound (farther down the arm or leg)?

This may mean that a nerve was damaged.

Yes

Numbness, tingling, or loss of feeling around or below an arm or leg injury

No

Numbness, tingling, or loss of feeling around or below an arm or leg injury

Do you think you may have a fever?

Are there red streaks leading away from the area or pus draining from it?

Do you have diabetes, a weakened immune system, peripheral arterial disease, or any surgical hardware in the area?

“Hardware” includes things like artificial joints, plates or screws, catheters, and medicine pumps.

Yes

Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area

No

Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area

Have you been stuck with a used or dirty needle?

Yes

Stuck with used or dirty needle

No

Stuck with used or dirty needle

Is there an object stuck in the wound, and you can’t get it out?

You may not be able to remove it because of where or how deep the wound is or because it causes severe pain.

Is the object large or small?

Large means things like a nail or piece of wood that is at least 2 in. (5.1 cm) long and anything bigger than that. Small means things like a pencil tip or a small splinter or sliver.

Large

Large embedded object

Small

Small embedded object

Did you have swelling or bruising within 30 minutes of the injury?

Yes

Swelling or bruising within 30 minutes of injury

No

Swelling or bruising within 30 minutes of injury

Has the swelling or bruising raised a lump that’s more than about 1. 5 in. (4 cm) across or deep? This would be bigger than a golf ball or Ping-Pong ball.

Yes

Lump bigger than golf ball or Ping-Pong ball

No

Lump bigger than golf ball or Ping-Pong ball

Do you have a puncture wound in your foot?

Yes

Puncture wound in foot

No

Puncture wound in foot

Did the object go through a shoe or boot?

An object that has enough force behind it to go through a shoe can cause serious injury to the foot. Puncture wounds in the sole of the foot also have a high risk of infection.

Yes

Object went through a shoe or boot

No

Object went through a shoe or boot

Do you think you may need a tetanus shot?

Yes

May need tetanus shot

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

• Your age. Babies and older adults tend to get sicker quicker.
• Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
• Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
• Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
• Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

• Try home treatment to relieve the symptoms.
• Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Symptoms of infection may include:

• Increased pain, swelling, warmth, or redness in or around the area.
• Red streaks leading from the area.
• Pus draining from the area.
• A fever.

Pain in adults and older children

• Severe pain (8 to 10): The pain is so bad that you can’t stand it for more than a few hours, can’t sleep, and can’t do anything else except focus on the pain.
• Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it’s severe when it’s there.
• Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

• Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
• Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
• Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Certain health conditions and medicines weaken the immune system’s ability to fight off infection and illness. Some examples in adults are:

• Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
• Long-term alcohol and drug problems.
• Steroid medicines, which may be used to treat a variety of conditions.
• Chemotherapy and radiation therapy for cancer.
• Other medicines used to treat autoimmune disease.
• Medicines taken after organ transplant.
• Not having a spleen.

With severe bleeding, any of these may be true:

• Blood is pumping from the wound.
• The bleeding does not stop or slow down with pressure.
• Blood is quickly soaking through bandage after bandage.

With moderate bleeding, any of these may be true:

• The bleeding slows or stops with pressure but starts again if you remove the pressure.
• The blood may soak through a few bandages, but it is not fast or out of control.

With mild bleeding, any of these may be true:

• The bleeding stops on its own or with pressure.
• The bleeding stops or slows to an ooze or trickle after 15 minutes of pressure. It may ooze or trickle for up to 45 minutes.

You may need a tetanus shot depending on how dirty the wound is and how long it has been since your last shot.

• For a dirty wound that has things like dirt, saliva, or feces in it, you may need a shot if:
  • You haven’t had a tetanus shot in the past 5 years.
  • You don’t know when your last shot was.
• For a clean wound, you may need a shot if:
  • You have not had a tetanus shot in the past 10 years.
  • You don’t know when your last shot was.

Symptoms of difficulty breathing can range from mild to severe. For example:

• You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
• It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

• Call your doctor today to discuss the symptoms and arrange for care.
• If you cannot reach your doctor or you don’t have one, seek care today.
• If it is evening, watch the symptoms and seek care in the morning.
• If the symptoms get worse, seek care sooner.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

• Call your doctor now to discuss the symptoms and arrange for care.
• If you cannot reach your doctor or you don’t have one, seek care in the next hour.
• You do not need to call an ambulance unless:
  • You cannot travel safely either by driving yourself or by having someone else drive you.
  • You are in an area where heavy traffic or other problems may slow you down.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Put direct, steady pressure on the wound until help arrives. Keep the area raised if you can.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Eye Injuries

Fishhook Injuries

Puncture Wound – Akshar Pediatrics

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Puncture Wound | Advocare Parsippany Pediatrics

Is this your child’s symptom?

• The skin is punctured by a pointed narrow object

If NOT, try one of these:

Causes of Puncture Wounds

• Metal: nail, sewing needle, pin, tack
• Pencil: pencil lead is actually graphite (harmless). It is not poisonous lead. Even colored leads are not toxic.
• Wood: toothpick

Complications of Puncture Wounds

• Retained Foreign Object. This happens if part of the sharp object breaks off in the skin. The pain will not go away until it is removed.
• Wound Infection. This happens in 4% of foot punctures. The main symptom is spreading redness 2 or 3 days after the injury.
• Bone Infection. If the sharp object also hits a bone, the bone can become infected. Punctures of the ball of the foot are at greatest risk. The main symptoms are increased swelling and pain 2 weeks after the injury.

When to Call for Puncture Wound

Call 911 Now

• Deep puncture on the head, neck, chest, back or stomach
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Puncture into a joint
• Feels like something is still in the wound
• Won’t stand (bear weight or walk) on punctured foot
• Needlestick from used needle (may have been exposed to another person’s blood)
• Sharp object or setting was very dirty (such as a playground or dirty water)
• No past tetanus shots
• Dirt in the wound is not gone after 15 minutes of scrubbing
• Severe pain and not better 2 hours after taking pain medicine
• Wound looks infected (spreading redness, red streaks)
• Fever occurs
• You think your child has a serious injury
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Last tetanus shot was more than 5 years ago
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

Care Advice for Puncture Wound

1. What You Should Know About Puncture Wounds:
   • Most puncture wounds do not need to be seen.
   • Here is some care advice that should help.
2. Cleaning the Wound:
   • First wash off the foot, hand or other punctured skin with soap and water.
   • Then soak the puncture wound in warm soapy water for 15 minutes.
   • For any dirt or debris, gently scrub the wound surface back and forth. Use a wash cloth to remove any dirt.
   • If the wound re-bleeds a little, that may help remove germs.
3. Antibiotic Ointment:
   • Use an antibiotic ointment (such as Polysporin). No prescription is needed.
   • Then, cover with a bandage (such as Band-Aid). This helps to reduce the risk of infection.
   • Re-wash the wound and put on antibiotic ointment every 12 hours.
   • Do this for 2 days.
4. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
5. What to Expect:
   • Puncture wounds seal over in 1 to 2 hours.
   • Pain should go away within 2 days.
6. Call Your Doctor If:
   • Dirt in the wound still there after 15 minutes of scrubbing
   • Pain becomes severe
   • Looks infected (redness, red streaks, pus, fever)
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Copyright 2000-2021. Schmitt Pediatric Guidelines LLC.

Puncture Wound | Advocare Hamilton Pediatrics

Is this your child’s symptom?

• The skin is punctured by a pointed narrow object

If NOT, try one of these:

Causes of Puncture Wounds

• Metal: nail, sewing needle, pin, tack
• Pencil: pencil lead is actually graphite (harmless). It is not poisonous lead. Even colored leads are not toxic.
• Wood: toothpick

Complications of Puncture Wounds

• Retained Foreign Object. This happens if part of the sharp object breaks off in the skin. The pain will not go away until it is removed.
• Wound Infection. This happens in 4% of foot punctures. The main symptom is spreading redness 2 or 3 days after the injury.
• Bone Infection. If the sharp object also hits a bone, the bone can become infected. Punctures of the ball of the foot are at greatest risk. The main symptoms are increased swelling and pain 2 weeks after the injury.

When to Call for Puncture Wound

Call 911 Now

• Deep puncture on the head, neck, chest, back or stomach
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Puncture into a joint
• Feels like something is still in the wound
• Won’t stand (bear weight or walk) on punctured foot
• Needlestick from used needle (may have been exposed to another person’s blood)
• Sharp object or setting was very dirty (such as a playground or dirty water)
• No past tetanus shots
• Dirt in the wound is not gone after 15 minutes of scrubbing
• Severe pain and not better 2 hours after taking pain medicine
• Wound looks infected (spreading redness, red streaks)
• Fever occurs
• You think your child has a serious injury
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Last tetanus shot was more than 5 years ago
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

Care Advice for Puncture Wound

1. What You Should Know About Puncture Wounds:
   • Most puncture wounds do not need to be seen.
   • Here is some care advice that should help.
2. Cleaning the Wound:
   • First wash off the foot, hand or other punctured skin with soap and water.
   • Then soak the puncture wound in warm soapy water for 15 minutes.
   • For any dirt or debris, gently scrub the wound surface back and forth. Use a wash cloth to remove any dirt.
   • If the wound re-bleeds a little, that may help remove germs.
3. Antibiotic Ointment:
   • Use an antibiotic ointment (such as Polysporin). No prescription is needed.
   • Then, cover with a bandage (such as Band-Aid). This helps to reduce the risk of infection.
   • Re-wash the wound and put on antibiotic ointment every 12 hours.
   • Do this for 2 days.
4. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
5. What to Expect:
   • Puncture wounds seal over in 1 to 2 hours.
   • Pain should go away within 2 days.
6. Call Your Doctor If:
   • Dirt in the wound still there after 15 minutes of scrubbing
   • Pain becomes severe
   • Looks infected (redness, red streaks, pus, fever)
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Copyright 2000-2021. Schmitt Pediatric Guidelines LLC.

Infected postoperative chronic wound of the right foot

attending physician: Galstyan Karina Oganesovna

Disease history:

• Male
• Age 54
• Height 179 cm
• Weight 100 kg

Diseases:

• Diabetes mellitus type 2, severe course, decompensation.
• Diabetic polyneuropathy.Diabetic foot syndrome, neuro-ischemic form. Extensive infected postoperative wound of the stump of the right foot. Wagner 3.
• Ischemic heart disease. Atherosclerotic cardiosclerosis. Insufficiency of blood circulation of the 2nd stage. Hypertension stage II. Hypertensive retinal angiosclerosis. Stage I obesity. Primary hypothyroidism, drug compensation. Chronic lymphocytic leukemia.

Anamnesis: The patient has been suffering from diabetes for 5 years.Receives insulin. On 10/04/2015 he received a stab wound in the area of ​​his right foot by stepping on the glass. On 15.10.2015, he was urgently admitted to the hospital, where the phlegmon was opened and 2-3 toes of the right foot were disarticulated. Due to a significant delay in healing, 23.11.15, he continued treatment in a specialized office “Diabetic foot”.

22.10.2015 (7th day after surgery)

General condition: moderate.Glycemia at the beginning of treatment is 13. 8 mmol / l. BMI 30.6 kg / m ² . HbA1c – 9.5 ‰.

Physique: hypersthenic

Mobility: no support on the right foot. Moves in a wheelchair.

Description of the wound: The right foot is moderately edematous, 2 and 3 toes are absent. In the projection of the base of the missing fingers, there is a postoperative wound measuring 10.0 x 3.0 cm and a depth of up to 2.0 cm. The bottom of the wound is covered with granulation tissue covered with a dense layer of fibrin.There are no purulent streaks and fluctuations. Moderate inflammation in the wound area is noted. Detachable fibrinous-sacral in moderate amount. The pulsation of arterial vessels in the area of ​​the right foot is significantly reduced.

11/23/15 (beginning of the use of Hydrotherapy)

The results of bacteriological examination of the separated wound: Corynebacerium striatum 10 ⁷ CFU / ml, Acinetobacter baumanii 10 ⁷ CFU / ml, Staphylococcus aureus detected 10 ⁷ CFU / ml, Enterococcus faecalis detected 10 ⁴ CFU / ml.

Drug therapy: Insulin therapy. Antihypertensive, diuretic, antiplatelet therapy (Lorista 50 mg x 2 times a day, Metoprolol 12.5 mg x 2 r / d, Indapamide 2.5 mg in the morning, Lasix 40.0 IV jet, Thrombo Ass 100 mg in the evening), gastroprotective therapy (Omez 20 mg in the evening).

Systemic antibiotic therapy: Ceftriaxone 2.0 IV, Metragil 100.0 IV drip No. 5. Further Sulmover 3 gr. x 2p / d + Vancomycin 1 gr. x 2 r / d – i / v.

Previous treatment:

Antibiotic therapy, taking into account the sensitivity of the isolated microflora to antibiotics.

Anti-inflammatory therapy (non-steroidal anti-inflammatory drugs), vasoprotectors.

Local therapy: an aqueous solution of chlorhexidine bigluconate, Betadine solution, Olazol foam, Levomekol water-soluble ointment.

Additional Information:

10/15/2015, on an urgent basis, an autopsy of the phlegmon and necrectomy with disarticulation of the 2nd and 3rd toes of the right foot were performed;

Unloading the right foot – moving in a wheelchair;

Despite the above therapy and supervision by a specialized specialist, the wound process has become protracted;

The treatment was carried out in inpatient and further outpatient conditions, in a specialized office “Diabetic foot”;

The patient did not always follow the doctor’s instructions;

The patient did not have the opportunity to visit regularly. Bandaged by his wife at home.

Preparations:

Drugs used in the study:

Basic dressings: HydroClean plus and HydroTac

Auxiliary dressings: Sterilux, Zetuvit E

Start date of treatment:

11/23/2015

End date of treatment:

21.01.2016 r.

The state of the patient’s wound during treatment: 02.12.2015 (10th day of treatment)

After dressings at home with HydroClean Plus

Wound condition: When the HydroClean dressing was removed, a weak positive dynamics of healing was noted, the inflammatory process and edema of the skin around the wound persisted, the area of ​​the wound surface slightly decreased in size 9.5 x 2.8 cm, granulations covered with a dense layer of fibrin remained.There is no accumulation of exudate in the wound. Exudation is moderate. The depth of the wound was reduced to 2. 5 cm. The skin of the foot is dry. The edges of the wound are smooth with signs of moderate maceration. The dressing is impregnated with fibrinous-sacral exudate.

Related information:

The wound is without signs of progression of the infection, the pain syndrome is practically absent. It was recommended to continue treatment with the HydroClean plus dressing. Additionally, a Zetuvit E dressing was used to contain the wound exudate.Insulin therapy. Vasoactive therapy.

The state of the patient’s wound during treatment: 12/21/2015 (29th day of treatment)

After dressings at home with HydroClean Plus

Wound condition: There is a clear positive dynamics of healing, the inflammatory process and edema of the skin around the wound decreased, the area of ​​the wound surface decreased in size 6.5 x 2.0 cm, the bottom of the wound is represented by granulation tissue.Fragmented fibrin overlays. Exudation is not expressed. The depth of the wound was reduced to 1.5 cm. The skin of the foot is dry. The edges of the wound are smooth without signs of maceration. The dressing is impregnated with blood exudate.

Related information:

The wound is without signs of infection, there is no pain syndrome. It is recommended to continue the local treatment with the HydroClean plus dressing, changing once every 3 days. Additionally, the Zetuvit E dressing is recommended to contain wound exudate.Unloading the foot. Insulin therapy. Vasoactive therapy.

Significant changes

There is a picture of active wound contraction and a pronounced positive dynamics of the use of HydroClean Plus in the form of a significant reduction in the wound area, a decrease in the amount of fibrin, and an increase in the amount of granulation tissue.

The state of the patient’s wound during treatment:

25.12.2015(33rd day of treatment)

Dressing with HydroClean Plus

Wound condition: Further positive dynamics of healing was noted, the inflammatory process and edema of the skin around the wound were minimal, the area of ​​the wound surface was reduced in size to 5. 0 x 2.0 cm. The bottom of the wound is represented by granulation tissue with islets of fibrin. Marginal epithelialization is noted. Exudation is negligible. The depth of the wound was reduced to 1.0 cm.The edges of the wound are smooth without signs of maceration. The dressing is impregnated with blood exudate.

Related information:

It is recommended to continue the local treatment with the HydroClean plus dressing, changing once every 3 days. Additionally, Sterilux dressing is recommended. Unloading the foot. Insulin therapy. Vasoactive therapy.

Significant changes

Further positive dynamics of the use of HydroClean Plus is noted in the form of a reduction in the wound area, an increase in the amount of granulation tissue and the appearance of edge epithelialization.

The state of the patient’s wound during treatment:

07.01.2016 (46th day of treatment)

After dressings at home with HydroClean Plus

Wound condition: Achieved reduction of the wound area in dimensions up to 3. 0 x 1.5 cm. The bottom of the wound is represented by active granulation tissue. Marked marginal epithelialization is noted. Scanty exudation. The depth of the wound was reduced to 0.5 cm.No skin maceration was detected. The dressing is impregnated with blood exudate.

Related information:

Taking into account the active dynamics of wound healing and cleansing, the appearance of active marginal epithelialization, it was decided to change the scheme of local therapy and continue treatment with the HydroTac dressing with a change once every 5-7 days. Unloading the foot. Insulin therapy. Vasoactive therapy.

Achieved changes when using HydroClean plus

When using HydroClean Plus, a significant reduction in the wound area and further activation of reparative processes in the wound were noted.

The state of the patient’s wound during treatment:

13.01.2016 (52nd day of treatment)

Dressing with HydroTac

Wound condition: Achieved reduction of the wound area in size up to 2. 5 x 1.5 cm due to pronounced marginal epithelialization. Scanty exudation. The depth of the wound is less than 0.5 cm. There is no inflammation and swelling in the wound area. HydroTac is impregnated with blood exudate.

Related information:

Taking into account the active dynamics of healing and epithelialization, it was decided to carry out further local treatment with the HydroTac dressing with a change once every 5-7 days. Unloading the foot. Insulin therapy. Vasoactive therapy.

Significant changes

With further use of HydroTac, further marginal epithelialization and reduction in the size of the wound defect were noted.

The state of the patient’s wound during treatment:

eighteen.01.2016 (57th day of treatment)

Dressing with HydroTac

Wound condition: The wound has decreased in size to 2.0 x 1.0 cm. Marginal epithelialization is active. The exudation is bloody, scanty. The depth of the wound is not more than 0. 3 cm. The HydroTac dressing is slightly saturated with blood exudate.

Related information:

Taking into account the active dynamics of healing and epithelialization, it was decided to carry out further local treatment with the HydroTac dressing with a change once every 5-7 days.Unloading the foot. Insulin therapy. Vasoactive therapy.

Significant changes

When using HydroTac, further active epithelialization is maintained with a satisfactory condition of the skin around the wound.

The state of the patient’s wound during treatment:

01.21.2016 (60th day of treatment)

Bandaging with HydroTac (performed ahead of schedule, on the 4th day at the request of the patient)

Wound condition: The wound has decreased in size to 1.5 x 1.0 cm.Granulation at the skin level. Active marginal epithelialization is preserved. Scanty exudation. HydroTac is slightly saturated with blood exudate.

Related information:

Taking into account the condition of the wound and active epithelialization, it was decided to complete the local treatment with the HydroTac dressing, changing once every 5-7 days. More active wound moisturization with the HydroTac transparent dressing is not required. Unloading the foot. Insulin therapy. Vasoactive therapy.

Significant changes

When using HydroTac, further active epithelialization is maintained with a satisfactory condition of the skin around the wound.

Final assessment:

Illustrations:

Change of dressings during treatment: HydroClean plus – once every 3 days, HydroTac – once every 5 – 7 days.

Final assessment of the condition of the wound on day 60:

There is a significant activation of reparative and regenerative processes, acceleration of the wound process in a chronic wound from complete cleansing of the wound to active granulation and epithelialization of the wound defect;

Signs of wound infection and acute inflammation around the wound are completely absent;

The area of ​​the wound surface in the course of treatment decreased 20 times, from 30. 0 cm ² to 1.5 cm ² ;

The use of Hydrotherapy made it possible to prevent infectious purulent complications in the patient, avoid repeated surgical treatment and skin grafting, and preserve the support function of the foot.

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90,000 causes, symptoms, diagnosis, treatment, prevention

It is tissue damage in which the depth of the wound channel is much greater than the width of the entrance opening.

Causes

Presumably the causes of a stab wound can be criminal incidents, it can be sharpening blows, an accident, for example, falling on a pin, as well as traffic accidents, industrial or natural disasters.

The clinical picture of a puncture wound depends on its location. It should be noted that such injuries should be treated with particular vigilance, since they do not exclude the possibility of severe injuries, even despite the small size of the inlet and the patient’s satisfactory condition.In the event that the wound was made by sharpening, the depth of the wound channel can vary from 15 to 20 centimeters with an entrance opening of only 1 or 2 centimeters. The depth of the wound inflicted with an awl can vary from 8 to 10 centimeters, and the length of the canal, which was left with a metal pin, is completely impossible to determine without surgical intervention.

If the wound is located in the area of ​​the neurovascular bundles, then this may be accompanied by damage to blood vessels and nerves. It should be borne in mind that the absence of pronounced external bleeding does not exclude the likelihood of damage to the vessels, since after the removal of a sharp object, the tissues are sometimes displaced, as a result of which the narrow wound channel is blocked and the blood flows not outside, but into natural cavities or nearby tissues.

The risk of injury to internal organs also depends on the location of the wound. In the case of localization of the wound in the chest area, trauma to the heart or lungs may occur, if the wound is located in the abdomen, then damage to the stomach, liver or spleen is possible, if the neck is damaged – the trachea, esophagus or larynx, the lumbar zone – the kidneys.When making a diagnosis, it is necessary to take into account that damage to an organ depends not only on the anatomical zone of damage, but also on the depth and direction of the wound channel. For example, if a puncture wound was inflicted on the abdomen directed upward, then lung or kidney damage may occur.

Symptoms

With fresh wounds on the skin, small wound openings of a rounded shape with smooth edges are found. In the event that the traumatic object was not removed and remained in the wound, then its edges outwardly look curved inward.Such wounds are most often accompanied by minor bleeding, the wound hole has a slit or angular shape, smooth edges.

For the most part, the clinical symptoms of a wound depend on its location, as well as the presence or absence of damage to internal organs, nerves and blood vessels. A rapid increase in weakness, dizziness and the appearance of a fainting state indicates that the victim has massive bleeding into the surrounding tissues. When injured in the chest, the patient may experience shortness of breath, as well as the development of pneumothorax or hemothorax, weakness, shock and percussion dullness of sound.When the wound is localized in the abdomen, damage to the parenchymal organs, such as the liver or spleen, may occur.

When the wound canal is infected, the edges of the wound are hyperemic, and serous or purulent discharge can be detected in the wound canal. Patients complain of intense twitching or throbbing pain. Such patients may experience symptoms of general intoxication, such as fever, chills, weakness, weakness, and headaches.

Diagnostics

The diagnosis is established on the basis of anamnesis, as well as the results of an external examination.The need for additional research depends on the patient’s condition and complaints, the location of the wound, the intended direction and depth of the wound channel.

To assess blood loss, the patient undergoes a general blood test, in case of suspicion of damage to the organs of the chest, X-ray can be performed, if damage to the organs of the abdominal cavity is suspected, laparoscopy.

Treatment

At the prehospital stage, with minor bleeding, the skin around the wound should be washed and disinfected, and only then a sterile dressing should be applied. In case of massive bleeding, one of the methods of temporary stop should be used. If a traumatic object remains in the wound channel, it should not be removed, as this can cause increased bleeding and the development of shock.

If there is a suspicion of damage to internal organs, nerves and blood vessels, the patient is referred to narrow specialists. In the presence of a fresh uncomplicated purulent infection of the wound, primary surgical treatment is indicated. To improve the outflow, puncture wounds must be drained with half-tubes or rubber graduates.Removal of drains occurs 1 or 3 days after the operation, the sutures are removed on the 8th or 10th day. After the surgical intervention, the patient is prescribed antibiotic therapy.

Prevention

Prevention of puncture wounds is based on adherence to measures aimed at preventing injury.

Injuries / ruptures of the flexor and extensor tendons

For the proper functioning of the hand, coordinated work of the flexor and extensor tendons of the fingers of the hand is necessary. There are no muscles in the fingers, so their flexion and extension is realized due to the tendons of the muscles that are located on the forearm. The flexor tendons are located on the palmar surface of the hand, the extensors are located on the dorsum just under the skin. Each toe has two flexor tendons, superficial and deep. The deep flexor is attached to the nail phalanges of the fingers and is responsible for their flexion, and the superficial flexor to the middle phalanges. Injuries to the flexors and extensors of the fingers of the hand are quite common due to the predominantly superficial arrangement of the tendons.When the flexors of the fingers are injured, the end of the tendon located proximally is pulled up, which makes it very difficult to find the ends of the tendon when it breaks. When the extensors are injured, the tendon practically does not move, therefore, it is easier to treat.

Types of damage

Symptoms

When tearing or tearing, the following symptoms are observed:

• In case of damage to the tendons on the palmar surface of the hand or fingers, there is a violation of the flexion function, due to which the fingers are in an overextended state
• In case of injuries to the dorsum of the hand, the extension function of one or more fingers is impaired
• Numbness of fingers and other sensory disturbances (with damage to nerves)
• Deformation of fingers
• Edema
• Hemorrhage
• Violation of the integrity of the tendons
• Visible damage to soft tissues (open form of trauma)

Which doctor should I contact

Diagnostics

Treatment

In case of damage to the extensors, two treatment options are possible: conservative and surgical. Injuries at the level of the fingers can be healed without surgery, but subject to prolonged wearing of plaster or plastic splints. In all other cases, as well as with injuries of the flexor tendons, surgical treatment is indicated. The operation is a complex surgical procedure, often using microsurgical techniques. It consists in dissecting the skin and suturing the ends of the torn tendon under local or local anesthesia. In the postoperative period, the arm must be fixed with a plaster cast.

When the ends of the tendons are disintegrated or disfigured, they are excised. In order to avoid postoperative flexion contracture, operations are performed to lengthen the tendon in the tendon-muscle part or its Z-shaped lengthening proximal to the damaged area.

In some cases, with chronic injuries of the flexor tendons of the fingers (the presence of defects of a tendon 2 or more centimeters long), the patient is shown plastic surgery of the tendons, or plastic with preliminary formation of the tendon canal using temporary endoprosthetics of the tendon with a silicone endoprosthesis. Most often, plastic surgery is performed in conjunction with other surgical interventions (revision of the tendons, tenolysis, etc.).

After any method of treating injuries to the extensors and flexors of the fingers of the hand, rehabilitation is necessary. For 3-5 weeks, the tendons grow together quite firmly, after which you can remove the plaster cast and, under the supervision of a doctor, begin recovery procedures.

Restoration of all necessary functions of the fingers includes: physiotherapy exercises to develop the hand, physiotherapy procedures, massage, salt baths and other procedures as prescribed by a doctor.

In Moscow, you can make an appointment with qualified specialists at the clinic of the Central Clinical Hospital of the Russian Academy of Sciences. Waiting for you.

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