Cuts, Scrapes, and Puncture Wounds

At some time in your life, you are bound to suffer an accident in which you scrape, cut, or puncture your skin—injuries in which the outer skin barrier has been penetrated. Symptoms range from narrow tears in the skin (cuts) to superficial abrasions (scrapes) to deep holes (punctures). Usually bleeding occurs, though some puncture wounds may bleed only slightly. Because any such injury leaves you prone to infection, the damage needs to be dealt with immediately.

Types of Injuries

A cut is typically caused by a sharp implement with an edge that may be smooth (a knife or a razor blade, for example) or jagged (a piece of broken glass). If the cut is deep, it will bleed profusely, and there may be damage to underlying muscle, tendons, and nerves.

A scrape results from skin being rubbed against a rough surface like pavement. The outer skin layer may not be completely broken, but because small blood vessels are ruptured, the skin may ooze blood.

A puncture wound is caused by a nail, pin, or other sharp object with a penetrating point.

Immediate Care for Cuts and Scrapes

Most minor cuts and scrapes will heal on their own. However, skin is a barrier against germs and infections, so ignoring cuts and scrapes, no matter how minor, can leave you vulnerable to infection. Deep cuts or puncture wounds require medical attention.

Many remedies—from hydrogen peroxide to Mercurochrome to antiseptic sprays and ointments—have enjoyed popularity over the years. The truth is, most small wounds can be attended to without much doctoring and will heal in a week to 10 days.

First, stop the bleeding—if there’s any amount of it—by applying pressure with a clean cloth or tissue. Since blood takes a while to clot, you may need to press down for as long as 10 minutes.

If blood soaks through the cloth or tissue, don’t remove it. Instead, apply another cloth on top of what you have in place and apply more pressure. If possible, elevate the wounded part above heart level to slow blood flow. (Exception: a puncture wound, from a nail or needle or similar long, sharp object, should be encouraged to bleed as part of the cleansing process.)

Second, avoid infection. This is the main concern with any small wound. You can best accomplish this by cleaning the wound and keeping it clean. Cleanse a scrape or cut by swabbing gently with a clean wet cloth or by holding the injured part under cold running water. Use a mild soap in the area, but try to keep it out of the wound per se because it can cause irritation. If there are dirt particles clinging to a scrape or cut, remove them with tweezers (wash the tweezers first and dip the tips in alcohol before using).

If you can’t wash the wound, lick it. Licking a wound is a time-honored practice that may actually help disinfect it and promote healing, according to a small study in The Lancet. Researchers found that nitrites in saliva react with the skin to make nitric oxide, a chemical that can kill bacteria. Saliva also contains other substances that can help in healing.

Apply a bandage. If the wound is likely to get dirty, if the area needs protection from further injury, or if you would just feel more comfortable, a homemade or store-bought adhesive bandage is in order. Change the bandage at least once daily to keep the wound clean.

Don’t pick. It’s a good idea to keep small wounds dry and expose them to air as soon as possible. While scabs may not be desirable for large or surgical wounds, they protect against infection in small wounds. Don’t pick a scab off—allow it to fall off after the skin has healed.

Don’t apply antiseptics. Contrary to myth, hydrogen peroxide does not cleanse wounds, but can irritate the skin and retard healing. Antiseptic solutions—rubbing alcohol, iodine, and hexylresorcinol—kill some microorganisms and the Food and Drug Administration (FDA) permits them to be sold for cleaning small wounds. But they really are not needed and in fact can be damaging. (Iodine can actually burn your skin under a tight bandage.)

Such solutions as Mercurochrome and Merthiolate (once medicine cabinet staples) contain mercury, which is highly toxic, and are not judged safe or effective by the FDA. For cuts and scrapes that are hard to keep clean, try Betadine (povidone iodine) ointment.

Antibiotic ointments are unnecessary for small wounds. These products offer no benefits for helping a wound to heal. If you want an ointment to keep a bandage from sticking to the wound, use petroleum jelly.

Immediate Care for Puncture Wounds

Help the bleeding. A puncture wound often doesn’t bleed freely, so bacteria, instead of washing away, may be sealed in. If such a wound is not bleeding enough, press gently around the wound to encourage bleeding.

Clean the wound. Examine the wound and remove any dirt particles or other foreign objects from it with tweezers. (Wash the tweezers first and dip in rubbing alcohol before using.) Clean the wound with soap and cool running water and cover it with a sterile dressing.

Reduce the risk of infection. A deep puncture wound on the hand may lead to an infection that is hard to combat; preventive antibiotic treatment may be advisable for such a wound. If the wound is deep or was made with a dirty object and you haven’t had a tetanus shot within 10 years, contact your doctor about tetanus immunization.

When To Seek Medical Help

In any of the following situations, call your doctor or go straight to the emergency room:

  • If bleeding comes in spurts. This indicates that an artery may have been cut and that you might not be able to stop the bleeding—cover the wound with a large, soft cloth, and if possible elevate it above heart level. Press directly on the wound to help stop blood flow; apply an additional compress on top of the first, if necessary. Don’t use a tourniquet, which can damage nerves.
  • If a cut looks very deep, or if the edges of the wound gap open—a jagged cut, particularly from broken glass, is likely to need medical attention. If you need stitches, you should not wait more than six hours to get them.
  • If a scrape is very large (for example, the whole length of your arm or leg) and there are bits of debris in it
  • If your face is cut—you may need plastic surgery to avoid scarring.
  • If you have a deep puncture wound, especially if it was made with a dirty object (for example, a gardening tool), and if you haven’t had a tetanus booster within the past 10 years—if more time has passed or you don’t remember when you last had one, arrange to have a tetanus immunization as soon as possible.
  • If you have a puncture wound of the head, chest, or abdomen—particularly if you experience numbness or tingling, which may indicate nerve damage
  • If you think a wound has hidden dirt or debris in it
  • If any sign of infection develops—signs include redness, swelling, or discharge; fever; red streaks spreading from the wound site

You may need to soak the wound to keep the puncture open and encourage draining.

After a careful examination a physician may administer a local anesthetic, and if you have a deep abrasion, the area will be cleaned completely. If necessary, deep cuts will be closed with stitches to eliminate the risk of infection and ensure proper healing. To reduce visible scarring due to cuts on the face, consult a plastic surgeon as soon as possible.

Tetanus

Tetanus is a serious, potentially fatal infection caused by bacteria. When the bacteria invade the body—for example, through a wound—they produce toxins that cause muscles to tighten and cramp painfully. The infection primarily affects the neck, chest, and stomach.

Tetanus is also called "lockjaw" because the muscles of the neck and jaw often lock, making it difficult to swallow or open the mouth. Tetanus infection can cause breathing problems, severe muscle spasms, and seizures, and may require several weeks of hospitalization in the intensive care unit (ICU). Complete recovery can take months.

It's important to get a tetanus booster shot every 10 years. If it’s been more than 10 years since your last inoculation, your doctor will give you a booster shot. For a severe, dirty, or contaminated wound, a booster shot is advised if it’s been more than five years since your last booster.

Bandages: Often Not Necessary

For most small wounds, keeping the wound dry and exposed to air will make it heal faster. A scab helps protect the area from infection and shouldn’t be removed until the wound has healed. But for temporary protection of a minor wound, ready-made bandage strips are fine. These come in a variety of shapes and styles for different small injuries.

Do buy: A generic-name bandage, since it is as good as any brand name, provided you can get the size and type you like. Waterproof bandages can be worth the extra cost if the wound is constantly exposed to water.

Don’t buy: Bandages with antiseptics (applying antiseptics to a wound isn’t a good idea anyway, as explained above); bandages with antibiotic creams (which can irritate the skin or induce allergic reactions, and offer few benefits); bandages with aloe or vitamin E on the pad (these aren’t worth paying extra for, since they will have little effect on a wound—and topically applied vitamin E may cause rashes in some people).

For certain large serious wounds, some studies have shown that moisture can aid healing. Flexible, transparent, waterproof bandages called occlusive bandages are designed to retain moisture around a wound and protect it from dirt and bacteria. Hospitals use occlusive bandages, but you can also find them in drugstores. However, if you have a wound serious enough for an occlusive bandage (which has to be changed at intervals if the wound is draining), you probably need medical advice.

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at HealthCommunities.com

Published: 24 Aug 2010

Last Modified: 17 Nov 2014