Cuts, Scrapes, and Puncture Wounds

If the wound begins to drain yellow or greenish fluid (pus), or if the skin around the wound becomes red, warm, swollen, or increasingly painful, a wound infection may be present and medical care should be sought.

Any red streaking of the skin around the wound may indicate an infection in the system that drains fluid from the tissues, called the lymph system. This infection (lymphangitis) can be serious, especially if it is accompanied by a fever. Prompt medical care should be sought if streaking redness from a wound is noticed.

The fastest way to heal an open wound is to follow the basic steps for wound care:

• Stop the bleeding. The first step in the care of cuts and scrapes (abrasions) is to stop the bleeding. Most wounds respond to direct pressure with a clean cloth or bandage. Hold the pressure continuously for approximately 10 to 20 minutes. If this fails to stop the bleeding or if the bleeding is rapid, seek medical assistance.
• Clean the wound. Next, thoroughly clean the wound with soap and water. Remove any foreign material in the wound, such as dirt, or bits of grass, which may lead to infection. Tweezers can be used (clean them with alcohol first) to remove foreign material from the wound edges, but do not dig into the wound as this may push bacteria deeper into the wound or injure subcutaneously (under the skin) structures. The wound may also be gently scrubbed with a washcloth to remove dirt and debris. Hydrogen peroxide and povidone-iodine (Betadine) products may be used to clean the wound initially but may inhibit wound healing if used long-term.
• Cover the wound. Cover the area with a bandage (such as gauze or a Band-Aid) to help prevent infection and dirt from getting in the wound. A first-aid antibiotic ointment (Bacitracin, Neosporin, Polysporin) can be applied to help prevent infection and keep the wound moist.
• Continue to care for the wound. Continued care of the wound is also important. Three times a day, wash the area gently with soap and water, apply an antibiotic ointment, and re-cover it with a bandage. Change the bandage immediately if it gets dirty or wet.

A puncture wound is caused by an object piercing the skin, creating a small hole. Some punctures can be very deep, depending on the source and cause.

Puncture wounds do not usually bleed much, but treatment is necessary to prevent infection. A puncture wound can cause infection because it forces bacteria and debris deep into the tissue, and the wound closes quickly forming an ideal place for bacteria to grow.

For example, if a nail penetrates deep into the foot, it can hit a bone and introduce bacteria into the bone. This risk is especially great if an object has gone through a pair of sneakers or tennis shoes. The foam in sneakers can harbor bacteria that can lead to a serious infection in the tissues. Additional common causes of puncture wounds can include animal or human bites, or splinters from wood or other plant material, which carry a high risk of infection and should be treated by a physician.

First aid for puncture wounds includes:

• Clean the area thoroughly with soap and water.
• If the area is swollen, ice can be applied and the area punctured should be elevated.
• Apply antibiotic ointments (Bacitracin, Polysporin, Neosporin) to prevent infection.
• Cover the wound with a bandage to keep out harmful bacteria and dirt.
• Change the bandage 3 times a day and monitor for signs of infection (the same signs as in the cuts section).
• Change the bandage if it becomes wet or dirty.

Most puncture wounds do not become infected, but if redness, swelling, or bleeding persists, see your doctor. People with suppressed immune systems or any particularly deep puncture wounds should also be seen by a doctor. If it is difficult to remove the puncturing object, it may have penetrated the bone and require medical care.

Puncture wounds to the feet are a particular concern. Wear shoes to minimize the risk of a puncture wound from a nail or glass, especially if the affected person has diabetes or loss of sensation in the feet for any reason.

Most people in the United States have been immunized against tetanus (lockjaw). If the affected person has been immunized, a booster shot can be given if they have not had one within 10 years. If it is a very dirty wound, a booster shot can be given within 5 years.

If the affected person has never had a tetanus shot, or if their series is incomplete (fewer than 3 shots), they might need tetanus immunoglobulin, a medication that can prevent lockjaw.

Any wound that shows signs of infection should be seen by a doctor.

You should also seek medical attention if:

• You cannot control the bleeding from a cut or scrape (abrasion)
• The cut goes beyond the top layer of skin or is deep enough to see into (may need stitches) Generally, the sooner the wound is sutured, the lower the risk of infection. Ideally, wounds should be repaired within 6 hours of the injury.

People with suppressed immune systems (including people with diabetes, cancer patients receiving chemotherapy, people who take steroid medications, such as prednisone, patients on dialysis, or people with HIV) are more likely to develop a wound infection and should be seen by a doctor.

People who are on blood-thinning medication and cannot control the bleeding should be seen by a doctor immediately.