Skin Trauma (Cuts/Scratches, Scrapes, Puncture Wounds, Bruises)

Skin Trauma Wound

Cuts And Scratches Definition

Most cuts are superficial and extend only partially through the skin. They are caused by sharp objects. The cuts that need sutures are deep and leave the skin edges separated. Another rule of thumb is that cuts need sutures if they are longer than 1⁄2 inch (1⁄4 inch if on the face).

Home Care Treatment

  • Apply direct pressure for 10 minutes to stop any bleeding.
  • Wash the wound with soap and water for 5 minutes.
  • Cut off any pieces of loose skin using a small scissors.
  • Apply an antibiotic ointment and cover it with a Band-Aid or gauze. Wash the wound, apply the ointment, and change the Band-Aid or gauze daily.
  • Give Acetaminophen or Ibuprofen, as needed, for pain relief.

Common Mistakes in Treating Cuts and Scratches

  • Don’t use alcohol or Merthiolate on open wounds. They sting and damage normal tissue.
  • Don’t kiss an open wound because the wound will become contaminated by the many germs from a person’s mouth.
  • Let the scab fa11 off by itself; picking it off may cause a scar.

CALL OUR OFFICE IMMEDIATELY if:

    • Bleeding won’t stop after 10 minutes of direct pressure.
    • The skin is split open and might need sutures. (Note: Lacerations must be sutured within 12 hours of the time of injury, and the infection rate is far lower if they are closed within 4 hours.)
    • There is any dirt in the wound that you can’t get out.
    • The cut looks infected (yellow pus, spreading redness, red streaks).

During regular hours if:

    • Your child hasn’t had a tetanus booster in more than 10 years (5 years for dirty cuts).
    • The wound doesn’t heal by 10 days.
    • You have other questions or concerns.

Scrapes (Abrasions) Definition

An abrasion is an area of superficial skin that has been scraped off during a fall (e.g., a floor burn or skinned knee).

Home Care

Cleaning the Scrape. First, wash your hands. Then wash the wound vigorously for at least 5 minutes with warm water and liquid soap. The area will probably need to be scrubbed several times with a wet piece of gauze to get out all the dirt. You may have to remove some dirt particles (e.g., gravel) with a pair of tweezers. If there is tar in the wound, it can often be removed by rubbing it with petroleum jelly, followed by soap and water again. Pieces of loose skin should be cut off with sterile scissors, especially if the pieces of skin are dirty. Rinse the wound well.

Antibiotic Ointments and Dressing

Apply an antibiotic ointment and cover the scrape with a Band-Aid or gauze dressing. This is especially important for scrapes over joints (such as the elbow, knee, or hand) that are always being stretched. Cracking and reopening at these sites can be prevented with an antibiotic ointment, which keeps the crust soft (no prescription is needed).

Cleanse the area once a day with warm water and then reapply the ointment and dressing until the scrape is healed.

Pain Relief. Because abrasions can hurt badly, give Acetaminophen or Ibuprofen for the first day.

CALL OUR OFFICE IMMEDIATELY if:

  • There is any dirt or grime in the wound that you can’t get out.
  • Skin loss involves a very large area.
  • The scrape looks infected (yellow pus, spreading redness, red streaks).

During regular hours if:

  • Your child hasn’t had a tetanus booster in over 10 years.
  • The scrape doesn’t heal by 2 weeks.
  • You have other questions or concerns.

Puncture Wounds Definition

The skin has been completely punctured by an object that is narrow and sharp, such as a nail. The wound is not wide enough to need sutures. Since puncture wounds usually seal over quickly, there is a greater chance of wound infection with this type of skin injury. Puncture wounds of the upper eyelid are especially dangerous and can lead to a brain abscess. A deep infection of the foot can begin with swelling of the top of the foot 1-2 weeks after the puncture. Another risk is tetanus if your child is not immunized.

Home Care

Cleansing. Soak the wound in warm water and soap for 15 minutes. Scrub the wound with a washcloth to remove any debris. If the wound rebleeds a little, that may help remove germs.

Trimming. Cut off any flaps of loose skin that cover the wound and interfere with drainage or removing debris. Use a fine scissors after cleaning them with rubbing alcohol.

Antibiotic Ointment. Apply an antibiotic ointment and a Band-Aid to reduce the risk of infection. Resoak the area and reapply antibiotic ointment every 12 hours for 2 days.

Pain Relief. Give Acetaminophen or Ibuprofen for any pain.

CALL OUR OFFICE IMMEDIATELY if:

  • Dirt in the wound remains after you have soaked the wound.
  • The tip of the object could have broken off in the wound.
  • The sharp object or place where the injury occurred was very dirty (e.g., a barnyard).
  • The wound looks infected (yellow pus, spreading redness, red streaks).

During regular hours if:

  • It has been at least 5 years since your child last had a tetanus booster.
  • Pain, redness, or swelling increases after 48 hours.
  • You have other questions or concerns.

Bruises Definition

Bleeding into the skin from damaged blood vessels gives a black and blue mark. Since the skin is not broken, there is no risk of infection. Bruises usually follow injury caused by blunt objects. Unexplained bruises can indicate a bleeding tendency. (Exception: “Unexplained” bruises overlying the shins are usually not a sign of a bleeding tendency; children often bump this area and then forget about it.)

Home Care

Bruises. Apply ice for 20-30 minutes. No other treatment should be necessary. Give Acetaminophen or Ibuprofen for pain. Avoid aspirin because it may prolong the bleeding. After 48 hours, apply a warm washcloth for 10 minutes, 3 times a day to help the skin reabsorb the blood. Bruises clear in about 2 weeks.

Blood Blisters. Do not open blisters; it will only increase the possibility of infection. They will dry up and peel off in 1-2 weeks.

CALL OUR OFFICE IMMEDIATELY if:

Bruises are unexplained and several in number.