Cuts and puncture wounds Information | Mount Sinai

Wound – cut or puncture; Open wound; Laceration; Puncture wound

A cut is a break or opening in the skin. It is also called a laceration. A cut may be deep, smooth, or jagged. It may be near the surface of the skin, or deeper. A deep cut can affect tendons, muscles, ligaments, nerves, blood vessels, or bone.

A puncture is a wound made by a pointed object such as a nail, knife, or sharp tooth. Puncture wounds often appear to be on the surface, but may extend into the deeper tissue layers.

The essentials of a good first aid kit include a variety of bandages, medications, and equipment to stabilize injuries until proper medical attention can be administered.

A laceration is a wound that is produced by the tearing of soft body tissue. This type of wound is often irregular and jagged. A laceration wound is often contaminated with bacteria and debris from whatever object caused the cut. A puncture wound is usually caused by a sharp pointy object such as a nail, animal teeth, or a tack. This type of wound usually does not bleed excessively and can appear to close up. Puncture wounds are also prone to infection and should be treated appropriately.

Stitches are primarily used if the cut is more that a quarter inch deep, is on the face, or reaches bone. Stitches help hold the wound together so it can heal properly. Stitches are removed between 3 to 14 days after they are put depending upon which area of the body was injured. Stitches on the face can be removed within 3 to 5 days but areas of high stress such as hands, elbows, and knees must stay in 10 to 14 days.

Venomous snake bites are medical emergencies and require immediate attention. A venomous snake bite can cause severe local tissue damage and often requires follow-up care. The right anti-venom can save a person’s life. Even though most snakes are not venomous, avoid picking up or playing with any snake unless you have been properly trained.

To treat a minor cut at home first wash your hands thoroughly with soap to avoid infection. Next wash the cut with mild soap and water.

Symptoms

Symptoms include:

• Bleeding
• Problems with function (movement) or feeling (numbness, tingling) below the wound site
• Pain

Infection may occur with some cuts and puncture wounds. The following are more likely to become infected:

• Bites
• Punctures
• Crush injuries
• Dirty wounds
• Wounds on the feet
• Wounds that are not promptly treated

First Aid

If the wound is bleeding severely, call your local emergency number, such as 911.

Minor cuts and puncture wounds can be treated at home. Prompt first aid can help prevent infection and thereby speed healing and reduce the amount of scarring.

Take the following steps:

FOR MINOR CUTS

• Wash your hands with soap or antibacterial cleanser to prevent infection.
• Then, wash the cut thoroughly with mild soap and water.
• Use direct pressure to stop the bleeding.
• Apply antibacterial ointment and a clean bandage that will not stick to the wound.

FOR MINOR PUNCTURES

• Wash your hands with soap or antibacterial cleanser to prevent infection.
• Rinse the puncture for 5 minutes under running water. Then wash with soap.
• Look (but do not poke around) for objects inside the wound. If found, don’t remove them. Go to your emergency or urgent care center.
• If you can’t see anything inside the wound, but a piece of the object that caused the injury is missing, also seek medical attention.
• Apply antibacterial ointment and a clean bandage that will not stick to the wound.

Do Not

• DO NOT assume that a minor wound is clean because you can’t see dirt or debris inside. Always wash it.
• DO NOT breathe on an open wound.
• DO NOT try to clean a major wound, especially after the bleeding is under control.
• DO NOT remove a long or deeply stuck object. Seek medical attention.
• DO NOT push or pick debris from a wound. Seek medical attention.
• DO NOT push body parts back in. Cover them with clean material until medical help arrives.

When to Contact a Medical Professional

Call 911 or your local emergency number if:

• The bleeding is severe or cannot be stopped (for example, after 10 minutes of pressure).
• The person cannot feel the injured area, or it doesn’t work right.
• The person is otherwise seriously injured.

Call your health care provider right away if:

• The wound is large or deep, even if the bleeding is not severe.
• The wound is more than a quarter inch (.64 centimeter) deep, on the face, or reaching the bone. Stitches may be needed.
• The person has been bitten by a human or animal.
• A cut or puncture is caused by a fishhook or rusty object.
• You step on a nail or other similar object.
• An object or debris is stuck. Do not remove it yourself.
• The wound shows signs of infection such as warmth and redness in the area, a painful or throbbing sensation, fever, swelling, a red streak extending from the wound, or pus-like drainage.
• You have not had a tetanus shot within the last 10 years.

Prevention

Keep knives, scissors, sharp objects, firearms, and fragile items out of the reach of children. When children are old enough, teach them to how to use knives, scissors, and other tools safely.

Make sure you and your child are up to date on vaccinations. A tetanus vaccine is generally recommended every 10 years.

Ball JW, Dains JE, Flynn JA, Solomom BS, Stewart RW. Skin, hair, and nails. In: Ball JW, Dains JE, Flynn JA, Solomom BS, Stewart RW, eds. Seidel’s Guide to Physical Examination. 9th ed. . St Louis, MO: Elsevier; 2019:chap 9.

Lammers RL, Aldy KN. Principles of wound management. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 34.

Simon BC, Hern HG. Wound management principles. In: Walls RM, Hockberger RS, Gausche-Hill M, eds, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 52.

Last reviewed on: 11/13/2021

Reviewed by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Wondering if your wound is healing or infected?

Our bodies are marvelous. They can fight invasions, mend bones, and regenerate new skin. Did you know that just minutes after sustaining an injury your body starts to heal itself?

However, sometimes the healing process doesn’t go so smoothly. Germs and bacteria can find a way in and cause infection. Does it feel like your wound is taking forever to heal – even just a simple cut? If it has been more than 30 days, then there is probably something amiss.

Remember, all wounds, even the simple ones, can turn into a chronic wound over time. Make sure you keep your eye on your injury throughout the healing process. So, how do you tell if a wound is healing or infected? Below we take a look at various signs to look out for.

Signs of Infection

Here are some symptoms to monitor if you suspect your wound is infected:

Warmth

Often, right at the beginning of the healing process, your wound feels warm. This is because the white blood cells are fighting germs or bacteria. But, if the injury is feeling warm after the first five days, it may mean your body is fighting to keep bacteria and infection away.

Redness

The area may be swollen, sore, and red in color right after you’ve sustained your injury. This is normal as blood is being sent to the area to supply oxygen and other nutrients for healing. But if the wound is still red and swollen after five days, it’s a sign that your body is not healing correctly.

Discharge

After the initial discharge of a bit of pus and blood, your wound should be clear. If the discharge continues through the wound healing process and begins to smell bad or have discoloration, it’s probably a sign of infection.

Pain

Pain is obviously normal after being injured. If you have a deep wound, the pain will most certainly be more prevalent. But if you feel long-lasting pain that is also a sign of infection, especially if it is not to scale with the size of the injury you’ve sustained. Your pain should decrease with pain medication and not get worse.

Fever

Once an infection has taken place, it will enter your bloodstream and spread through your body, causing fever and general discomfort.

If you believe your wound may be infected, we can help.

Signs of Healing

Below we share some common wound healing factors that indicate your wound is well on its way to recovery:

Scabs

Your general cuts and puncture wounds go through three stages of healing: bleeding, clotting, and scabbing. If you find your wound is still bleeding after a significant period and no scab is forming, you may need to seek further care.

Swelling

Swelling is a sign that your immune system is repairing your wound. The blood vessels widen to ease blood flow and send oxygen, vitamins, and minerals to your injury. This stage shouldn’t last longer than five days.

Tissue Growth

After the swelling has stopped, you’ll notice new tissue forming over the wound – this usually lasts a couple of weeks.

Scarring

This is proof that healing has occurred. The initial scab will fall away, and you will be left with a scar. It may be with you for many years if your injury was severe or just slowly fade away.

If You Think Your Wound Might Be Infected or Is Not Healing

If you are struggling with a wound or find your body’s wound-healing capabilities are compromised, R3 Wound Care and Hyperbarics can help.  We work to assess each patient and then recommend the right treatment plan for healing open wounds. Each of our 8 Texas clinic locations has state-of-the-art equipment, skilled wound care specialists, and a comfortable atmosphere. At R3 Wound Care & Hyperbarics, our primary function is wound care treatment, and we are independent of any hospital. You don’t even need a referral from a doctor to make an appointment or receive treatment.  Whether you are in or near Dallas, San Antonio or Houston Texas – we can help.

For further questions or to make an appointment for evaluation, find the R3 Wound Care and Hyperbarics clinic nearest to you.

Soft tissue wounds – health articles

11/10/2022

What are soft tissue wounds?

Soft tissue injuries include injuries to the skin, mucous membrane, deep-lying tissues (subcutaneous tissue, muscles, etc.), as well as tendons, vessels and nerves. As a result of violation of the integrity of the skin, microbial contamination of the wound surface occurs, which can lead to the development of infection.

According to the damaging factor, wounds are divided into mechanical, thermal (burn) and chemical; on the instrument of injury – on wounds from blunt, sharp objects, tools and weapons, firearms and weapons; according to the nature of the damage, the wounds are classified into bruised, torn, combined, bitten, stab, cut, stab-cut, chopped, sawn, combined bullet, shot, fragmentation.

According to the depth of damage, superficial wounds are distinguished, located in different layers of the skin, and deep, passing in deeper tissues. Wounds of internal organs and joints that communicate with the external environment through a wound channel are called open wounds, and wounds whose wound channels pass through cavities or terminate in them are called penetrating wounds. Wounds of internal organs that do not communicate with the external environment are classified as closed.

Causes

Cut wounds result from the direct impact of a sharp weapon on the surface of the skin.

Chopping wounds are caused by lowering a sharp weapon on the skin at an angle.

Puncture wounds are the result of deep penetration of a sharp thin instrument. Possible injury to the cavities or joints.

Contusion wounds occur when some part of the body comes into contact with a hard obstacle and there is a solid support in the form of the bones of the skull or other bone.

Crushed, crushed wounds are formed due to the impact of a blunt instrument with a wide surface when opposed to a solid support.

Bite wounds. As a result of a bite by an animal or a person, highly virulent causative agents of wound infection can enter the wound.

Symptoms

A closed injury can be suspected by knowing the mechanism of injury (eg, blunt force impact) and by the presence of one or more of the following: bruising, swelling, pain.
Some signs suggest the nature of the injury. For example, swelling and deformity may indicate a closed fracture. A bruise on the head, bloody discharge from the nose, ears and mouth – an injury to the cervical spine or brain is possible. Bruises on the chest, deformation, violation of symmetry – a chest injury is possible with damage to the ribs and sternum. Respiratory failure may indicate lung injury. Large bruises on the abdomen – possible injury to the internal organ.

Signs of a wound vary depending on the type and depth of tissue damage. As a rule, any damage accompanies pain, possibly a violation of the integrity of the skin, as well as bleeding.

Diagnosis

For small, superficial wounds that are not accompanied by general symptoms, the diagnosis is made on the basis of the clinical picture. A detailed study is carried out during the primary treatment of the wound. With extensive and deep wounds with a violation of the general condition, additional studies are needed, the list of which is determined taking into account the location of the damage. In case of injuries in the chest area, a chest x-ray is prescribed, in case of damage to the abdomen, an x-ray of the abdominal cavity, ultrasound or laparoscopy, etc. If a violation of the integrity of blood vessels and nerves is suspected, a consultation of a neurosurgeon and a vascular surgeon is required.

Treatment

First medical aid consists of primary surgical treatment of the wound, during which foreign bodies are removed from the wound, bleeding stops, the wound is washed with antiseptics, and non-viable tissues are excised. The issue of prevention of tetanus and rabies (if the wound is bitten) is also being resolved. Wounds with a pronounced inflammatory process are not sutured, they are drained. An infected wound heals by secondary intention. Dressings and drains are changed daily. General treatment consists of anti-inflammatory therapy, the introduction of hemostatic agents, painkillers.

In case of profuse blood loss, the issue of compensating the volume of circulating blood (CBV) is solved, blood substitutes, blood components are introduced. Subsequently, with severe cicatricial contractures and deformities, a restorative operation can be repeated.

Most superficial wounds do not bleed much. Therefore, help consists in bandaging the wound. Before this procedure, the edges are smeared with an antiseptic, making sure that it does not get into the wound.

The wound is covered with a sterile dressing and bandaged. If the edges of the wound are strongly dispersed, before applying the bandages, they must be brought together (but not until they close) and fixed in this position with 2-3 strips of adhesive tape.

The wound must not be washed with water (risk of infection), nor with alcohol or tincture of iodine. The disinfectant solution, getting into the wound, causes the death of damaged cells, and also causes significant pain. No ointment should be applied to the wound, and cotton should not be placed directly into the wound.

Vitamin therapy should not be forgotten. Vitamin deficiency sharply slows down reparative (restorative) processes.

To accelerate wound healing, proper nutrition of patients is important, especially those who have undergone traumatic shock, severe infection or major surgery. They need a complete diet with an increased amount of protein and vitamins. Physiotherapy exercises are indicated primarily for purulent wounds of the upper extremities. Physiotherapeutic procedures play an important role: UV, UHF, etc.

Types of wounds and methods of their treatment

Wounds are the most common type of mechanical damage. This problem is relevant for all people, regardless of gender and age. Injuries can be minor or, on the contrary, extensive, but they are all equally dangerous, since even a minor wound can cause infection. Small cuts can be easily managed at home, but large cuts are difficult to localize with available tools and are one of the most common reasons people go to the emergency room. Whatever the wound, it is necessary to take measures for its treatment immediately after detection. Delay in taking action can lead to serious complications.

A wound is a soft tissue injury resulting from a violation of the integrity of the skin or mucous membrane. Wounds are classified according to a number of parameters. Such as the cause of occurrence, depth, localization, and so on.

There are many types of soft tissue injuries. Types of wounds are distinguished by the size of the damage zone. The most common types of wounds are stab, cut, lacerated, and wounds with damage to blood vessels.

Stab wounds have even edges, but the depth of damage exceeds its length. Such wounds are dangerous because they exclude the possibility of surgical intervention, and are also most susceptible to infectious complications.

With incised wounds that have a shallow depth, inferior in size to the length, and smooth edges, the damage has a small area. Such wounds heal easily and are less prone to suppuration.

Lacerations are characterized by large areas of soft tissue damage, contamination and necrosis. Among such wounds, scalped, bruised and crushed can be distinguished.

Of particular danger are wounds with damage to blood vessels, which are characterized by large blood loss and increased vulnerability to various infections, in addition, such wounds are not very prone to self-epithelialization and require additional measures.

When solving this problem, wound dressings are increasingly used. One of the most important functions of such a coating is to protect the damaged area from environmental pathogens, as well as to provide mechanical protection. However, now the functionality of dressings is not limited to just protecting the damaged area from infection, modern dressings contribute to the speedy healing of damaged tissues. For the manufacture of dressings, many manufacturers use various ointments, as well as clustered silver.

The type of dressing used is determined mainly by the nature of the injury.

Bandages containing special ointments, antiseptics or silver are suitable for the treatment of stab or cut wounds. Such a coating absorbs blood and other secretions, tightens the edges of the wound and promotes its speedy healing. This whole process takes about 5-7 days. During this time, a daily dressing change is necessary.

In the case of lacerations, the most effective means are tamponated dressings with an absorbent effect or consisting of calcium alginate fibers. They are placed directly into the wound. The absorbent pad absorbs exudate, and the medicinal substances contained in it quickly restore damaged soft tissues. While the alginate dressing, due to secretions, turns into a gel that fills the wound along its entire depth. In addition, in both cases, the moist environment necessary for healing is maintained.

For purulent wounds, and those in which necrotic tissue is formed, dressings are needed that can dissolve purulent discharge and dead tissue.

For infected wounds, sterile ointment dressings containing silver ions and antiseptics are best suited.

For poorly healing wounds, it is recommended to use dressings consisting of absorbent polyacrylate.

In addition to the above types, there are also a number of other dressings designed to accelerate the healing process of not only one type of wound, but also universal, promoting the epithelization of the damaged area of ​​the skin, regardless of the nature of the damage.

There are also dressings that are suitable for the treatment of trophic ulcers and bedsores of various degrees. These dressings contribute to the rapid dissolution of necrotic tissue, the removal of inflammation and the restoration of the skin.

The method of applying each type of dressing is only partly individual. However, do not neglect reading the instructions.

For most wound dressings, the following application method is applicable:

– Take the dressing out of the package

– Remove the protective layer from the surface adjacent to the skin

– Apply a dressing so that its edges protrude 2 to 3 cm beyond the wound

– In the case of ointment and non-adhesive dressings, fix the product with a secondary dressing

Wound dressings, as a rule, have no special contraindications, the only limitation in use may be a special sensitivity to certain substances that make up the product. Before using bandages, you should consult with a specialist.

Summing up, it is worth saying that for all the variety of existing dressings, it is important to find the right one for you. With various injuries, both serious and minor, it should be understood that the bandage is only part of the comprehensive treatment that the doctor will prescribe.