By eMedical Offices
Whether you slip on the ice and suffer an abrasion or are injured while gathering wood for the fireplace, how do you decide if a wound needs stitches? There are several issues that have to be taken into account when answering to that question. You’ll also need to determine if the wound should be treated with antibiotics, if it requires a specialist’s care, such as a plastic surgeon, or if a tetanus shot is needed. In this post I’ll discuss some of the factors doctors use to decide how to treat wounds.
What to do First
The first thing to do if you or your child is wounded is to put direct pressure on the wound to try to stop the bleeding. If the wound is in an area that can’t be compressed or it’s too painful to apply pressure directly to the wound, try applying pressure above the wound or elevating the area. Ice can also be helpful in stopping the bleeding and can decrease swelling as well. If the would is dirty, it should be washed with soap and warm water and rinsed with warm water to help remove any large particles of dirt and debris.
A Physician Evaluation
When examining a wound, your doctor will evaluate:
The age of the wound: In general, the longer it takes to heal, the higher the risk of infection. The best approach is to repair the wound within 2 to 4 hours. Bacteria can grow in a dirty wound within 3 to 4 hours. However, wounds in vascular areas (such as the face) can be safely closed within 24 hours as long as the wound is thoroughly cleaned. Because there is no definitive rule, it’s important for each injury to be evaluated by a physician, who can determine the best course of care.
Any underlying medical conditions: Certain factors put the wound at higher risk for infection, such as the patient’s age or other medical conditions. Very young and very old patients are at higher risk of infection due to lowered ability to fight infection. Certain medical conditions – diabetes, congestive heart failure, kidney disease, liver disease, blood disorders, immune disorders, cancers and malnutrition – can weaken the immune system and increase risk of infection. Also, treatments such as chronic steroid use, chemotherapy or radiation therapy can put patients at higher risk. Being able to provide your or your child’s immunization history is important. This should include date of last tetanus shot and if the full series of tetanus immunization has been completed.
Type of wound:
- Abrasions are caused by friction of the skin on a hard surface, resulting in injury to outer layer(s) of skin
- Lacerations are caused by a tear in tissues, which can be produced by shear forces, such as a knife, or compressive forces, such as hitting your forehead on a car dashboard.
- Crush wounds are caused by the impact of an object against tissue, particularly over a bony surface, which compresses the tissue.
- Puncture wounds are those with a small opening whose depth can’t be entirely viewed.
- Avulsions are wounds in which a portion of tissue is completely separated from its base and is either lost or left with a narrow base of attachment (a flap).
- Combination wounds are the result of a combination of the above types of wounds.
Possible contamination of the wound: All traumatic wounds are contaminated to some extent with bacteria. Any wound that has been exposed to biological fluids (saliva, blood or feces) or those exposed to vegetation, soil or water will be at high risk for infection. Abrasions, crush wounds and avulsion injuries are at higher risk of infection due to injury to tissues. Puncture wounds are at higher risk because it’s more difficult to fully explore, clean and rinse the wound.
Location of the wound: Wounds in areas where capillaries carrying blood are close to the skin surface, such as the scalp or face, are at lower risk of infection; wounds on the extremities such as hands, fingers, feet and toes will be a higher risk. Your doctor should only prescribe antibiotics after careful examination, decontamination and review of risk factors for infection. Any involvement of tendons, ligaments, bones, muscles or nerves may require surgery.
Treating the Wound
Once the wound has been evaluated and the doctor has decided that it needs to be sutured, the area will be prepped with an antiseptic cleaner. A local anesthetic is injected around the edge of the wound to numb the area and decrease the bleeding. This tends to be the most painful aspect of the procedure since the anesthetic can cause burning and stinging. For children, an anesthetic cream may be applied to the wound before local anesthetic is injected to minimize pain.
After the wound has been numbed, it will be thoroughly cleaned and examined for tissue damage, foreign objects and contamination. If you have a deep wound, a layer of dissolvable sutures may be used. The top layer of skin may be closed with nylon sutures strong enough to hold the wound closed. Staples are another option for closing large lacerations on areas such as the scalp.
BioGlue, a sterile surgical adhesive, also can be used to close the wound. It works best for straight cuts that aren’t over areas that are frequently bent, such as joints. The adhesive may be used without anesthesia, but wounds still require careful cleaning, rinsing and examination.
Generally, sutures stay in for five days in areas like the face, and up to 10 days in areas like the scalp. These time frames can vary based on location of wound and how much tension is on the sutures. If the injury was at high risk for infection, antibiotics may be prescribed. If you aren’t prescribed antibiotics, you may be asked to return to your doctor’s office in 24 to 48 hours to check for any signs of infection.
The wound should be kept covered with non-stick gauze and triple antibiotic ointment to help keep the wound moist, prevent infection and decrease scarring. All lacerations will result in a scar, which may not be apparent for 6 to 12 months. Avoiding direct sunlight to further decrease scarring.
If you need medical attention for a non-life-threatening illness or injury, eMedical Offices is open during the evening hours to treat walk-in patients. If you have questions about medical conditions, download iTriage from the iTunes or Android Marketplace, or check out iTriageHealth.com for your healthcare answers.