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WoundsIntroduction Cuts and grazes are among the most common of all injuries. Minor cuts and grazes (that do not go right through the skin) usually heal without causing any problems unless they become infected, or cause an unwelcome visible scar. Deeper cuts may damage important structures below the skin, such as nerves, blood vessels, or tendons. A cut, or laceration, is a tear, or split, in the skin. They are usually caused by a sharp edge of some kind, and some are more serious than others. A cut to the surface of the skin will often scab over and heal with little, or no, treatment. However, there may be a risk of a cut becoming infected, or leaving a scar once it has healed. Deeper, full thickness cuts can be very serious, particularly if they sever arteries, or other structures, such as veins, or nerves. Grazes A graze, or abrasion, is an injury to the skin, where the skin is scraped off against a rough surface. Most grazes only take off the surface layer of skin which leaves a raw tender area underneath. However, some grazes can be much deeper and, in rare cases, the deeper layers of skin can be removed. Falls, scrapes and friction burns can all cause grazes. Most cuts and grazes can be easily treated at home. However, more severe cases may need medical attention, such as stitches (sutures) to close the wound. The most common complication which can occur from a cut or graze is an infection, such as tetanus. When should I seek medical help for a cut or laceration? Most clean minor cuts and grazes can be managed at home by cleaning the wound and applying a simple dressing, such as a suitable sized plaster. However, you should seek medical help in the circumstances outlined below. When the cut is deep and there is a possibility that structures below the skin may be injured. Signs of this include: numbness which indicates an injury to a nerve, blood spurting from the wound, or bleeding that does not stop after five minutes of continuous firm pressure (this may indicate an injury to a major blood vessel), and any deep cut to the palm of the hand, or sole of the foot, that may cause injury to tendons. The cut is at risk of becoming infected. Signs of this include: the cut has become contaminated with things such as soil, faeces, or saliva, the cut was made by something that may have been in contact with things such as soil, faeces or saliva, and where fragments of material can be seen in the wound, or in cases where the cut has been caused by glass, shards of glass may be inside the wound, but unseen. The cut cannot be properly closed with a suitably sized plaster. Signs include: any gaping cut, when the edges of the cut cannot easily be brought together with a plaster, or when the edges of the cut are pulled apart by normal movement, such as a cut over the knee, and any cut where a visible scar is unwelcome, such as on a prominent part of the face. The cut or graze has become infected, indicated by: swelling of the affected area, pus in or coming from the wound, redness spreading from the wound, or increasing pain from the wound. Occasionally, in the case of more serious infections, you may develop a fever, feel unwell, and develop swollen glands. Symptoms Minor cuts and grazes may bleed and feel slightly painful. The affected area will normally scab over and heal quickly. However, if the cut is near an area that is constantly moving, such as around your joints, like the knees and elbows, it may take longer to heal. Depending on how deep the cut is, and what part of your body is affected, a small scar may remain once the cut has healed. Signs of infection in cuts and grazes Any minor cut or graze should heal fairly quickly. However, there are signs to look out for which can mean that your cut or graze is infected. These signs may include: loss of sensation (if a nerve has been cut), pulsatile bleeding, where blood spurts from the wound (if an artery has been severed), swelling of the affected area, pus forming in, and around, the affected area, redness spreading from the cut or graze (erythema), increasing pain in the wound, feeling generally unwell, fever, and swollen glands (lymph nodes). If you have a cut or graze, and notice any of these symptoms, you should see your GP as soon as possible. Complications Infection is the most common complication of cuts and grazes. If you have a wound that becomes contaminated by soil, faeces or saliva, you are at risk of getting tetanus (a severe bacterial infection). Severe cuts and grazes can also cause damage and scarring to your internal system. Further information about the possible complications of cuts and grazes are detailed below. Infection Approximately 3.5% of people admitted to hospital with cuts and grazes develop an infection. People who are most at risk of developing infections include diabetics, those with weakened immune systems (such as those undergoing chemotherapy, or those with HIV or AIDS), and the elderly. Infections can be treated using antibiotics. Tetanus Tetanus is a serious infection that you can get if bacteria enter your body through a wound, such as a cut or a graze. The bacteria then release a toxin (poison) which affects your nerves, causing your muscles to spasm (twitch). Tetanus can also cause a spasm in your 'chewing muscles', which can make it very difficult to move and open your mouth (known as lockjaw). If you notice any of these symptoms after a cut or a graze, you should seek medical attention immediately. Tetanus can be treated with antibiotics, but, if left untreated, the infection can be fatal. Damage to your internal system Cuts and grazes that are particularly deep can cause damage to your internal system, such as your nerves, blood vessels, muscles, tendons, and bones. If your nerves and tendons have been injured, you may have long term problems with movement and feeling in the affected area. Scarring Scars can form if your cut or graze is very deep, or if you pick at a scab. They are more likely to form on areas such as the knees and elbows. If you feel self conscious about a scar, there are treatments available without a prescription from pharmacies, such as creams and gel sheets, which may be able to minimise its appearance. In some cases, your GP may be refer you to a skin specialist for treatment, or you may be able to have surgery to make the scar less noticeable. Prevention It may not always be possible to avoid a cut or a graze, so it is a good idea to have a first aid kit at home, work and at school in case of accidents. There are also several precautions that you can take to minimise the risk of cuts and grazes, which are outlined below. When using sharp tools, always take care and wear any protective clothing provided. Chop food away from yourself, and pass scissors with the sharp ends pointing away from the person you are giving them to. When doing manual work, including DIY and gardening, you can avoid many injuries by wearing protective clothing and strong gloves. Be careful when the roads and pavements are icy and slippery. Consider wearing long sleeves, a helmet, and other protective equipment (such as knee and elbow pads) when doing outdoor activities, such as cycling or skateboarding. Treatment Most cuts and grazes are minor and can be easily treated at home. However, if your injury is more severe, you may need to receive treatment in hospital. Treatments for minor cuts and grazes, as well as more severe injuries, are detailed below. Treating minor cuts and grazes For most cuts and grazes, cleaning them thoroughly, and covering them with a plaster, or dressing, is usually all that is needed. If your cut or graze is bleeding heavily, or is on a particularly delicate area of your body, such as the palm of your hand, you should stop the bleeding before applying any kind of dressing. Apply pressure to the area to stop the bleeding using a bandage, or a towel. If the cut is to your hand, or arm, you should raise the affected area above your head. If the injury is to a lower limb, lie down and raise the affected area above the level of your heart so that the bleeding slows down and stops. To dress a cut or graze at home: wash and dry your hands thoroughly, clean the wound under running tap water, but do not use antiseptic because it may damage the tissue and slow down healing, pat the area dry with a clean towel, and apply a sterile, adhesive dressing, such as a suitably sized plaster. The wound should heal by itself in a few days. If the wound is painful, you can take painkillers, such as paracetamol, or ibuprofen. However, you should not take ibuprofen if you have a condition, such as a stomach ulcer. When taking medication, such as ibuprofen, always check the packaging for recommendations regarding usage and dosage. Ask your GP if you are unsure about whether or not it is suitable for you. You should not take ibuprofen if you have asthma, and children under the age of 16 should not take aspirin. You should also take care to keep the wound and dressing dry and clean, by changing it as often as necessary. If you are unsure how serious your injury is, or if it has not healed after a few days, you should see your GP. Always seek medical advice if: your injury does not stop bleeding, or if it is on a joint crease, or to an artery (go straight to A&E if this is the case), your injury is very large, or very deep, your injury was caused by a bite (all bites need medical attention), or there is something embedded (stuck) in your cut or graze. It is important to keep an eye on any cut or graze in case it becomes infected. If you notice any of the following signs or symptoms, see your GP as soon as possible: swelling of the affected area, pus forming in and around the affected area, redness spreading from the cut or graze (known as erythema), increasing pain in the wound, feeling generally unwell, fever, and swollen glands (lymph nodes). Treating severe cuts and grazes If you have a cut that is too severe to treat at home, go to your local NHS Walk-in centre or accident and emergency (A&E) department. Go straight to A&E if the cut is to an artery, or if the bleeding will not stop. At the hospital, a healthcare professional will examine your cut to determine whether or not there is any risk of infection. Factors which make an injury more prone to infection include jagged wound edges and any foreign object that is inside the cut. If there is glass inside your cut, you may need to have an X-ray so that the healthcare professional who is treating you can make sure that it is all removed. If there is no risk of infection, the healthcare professional will clean your cut using water, or a sterile saline solution, before closing it. This may be done using stitches (sutures), tissue adhesive, or skin closure strips. These are described below. Stitches (sutures) - these are usually used to close cuts that are more than 5cm long, or wounds that are particularly deep. Stitches are made from a sterile surgical thread, which is flexible and allows the wound to move. If your cut needs stitches, you will have a local anaesthetic, which means that you will be awake, but will lose feeling in the area of your cut. Tissue adhesive - this may be used to close less severe cuts that are under than 5cm long. The tissue adhesive is applied as a paste which is painted onto your skin, over your cut, while the edges are held together. The paste then dries, forming a flexible layer which keeps the cut closed. Skin closure strips - these may be used as an alternative to tissue adhesive, for cuts that are less than 5cm long, where there is a risk of infection. The strips are adhesive (sticky) and are placed over the edges of cut, to hold them together. They are easier to remove than tissue adhesive. Once your cut is closed, a healthcare professional may cover it with a protective dressing to ensure that your stitches (sutures), tissue adhesive, or skin closure strips stay in place. If you have had stitches (sutures), or skin closure strips, you will need to return to the hospital after a few days to have them removed. Tissue adhesive comes off by itself naturally after a week or so. You should never try and remove stitches yourself; they should only be removed by a healthcare professional. To prevent tetanus (a serious bacterial infection), you may be given a tetanus booster. If the healthcare professional treating you thinks that you are at risk of developing tetanus, you may be referred for specialist treatment. If there is risk of infection or your cut is already infected, a healthcare professional may take a sample for analysis using a swab, before cleaning it as usual. However, they will not yet be able to close your cut because this may trap any infection inside it, making it much more likely to spread. Instead, they will pack your cut with a non-adhesive (non-sticky) dressing so that it cannot close, before covering it with a protective dressing. You may also be given antibiotics to fight the infection. You will need to return to hospital after three to five days so that your cut can be assessed to see if any infection has cleared up. If so, your cut will be closed using stitches (sutures) or skin closure strips. Tissue adhesive will not be used as it is difficult to remove if infection occurs. If your infection has not cleared up, a change of antibiotics may be required. Skin grafts If your graze is very severe, and you have lost a lot of skin, you may need to have a skin graft. Your surgeon will take some skin from another part of your body and put it over the wound. After a while it will heal and look normal. Many essential oils can help to cleanse and treat wounds. Lavender has been used for thousands of years for this purpose and its very name comes from the Latin “lavare” to wash as it was used to wash out wounds. This oil can be used neat on the wound. Myrrh was similarly used by the Greeks and is especially useful if the wound is slow to heal and weepy, and Tea Tree although a more recent addition to the West was used for hundreds of years by the Aborigine people in Australia. The best way to use these oils is to put a few drops on a plaster or gauze before applying to the wound. Other essential oils which are suitable for use are Benzoin, Bergamot, Eucalyptus, Juniper and Rosemary. |
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