Cuts, Scrapes and Stitches: Caring for Wounds

How should I clean a wound?
The best way to clean a cut, scrape or puncture wound (such as from a nail) is with cool water. You can hold the wound under running water or fill a tub with cool water and pour it from a cup over the wound. Use soap and a soft washcloth to clean the skin around the wound. Try to keep soap out of the wound itself because soap can cause irritation. Use tweezers that have been cleaned in isopropyl alcohol to remove any dirt that remains in the wound after washing.
Even though it may seem that you should use a stronger cleansing solution (such as hydrogen peroxide or an antiseptic), these things may irritate wounds. Ask your family doctor if you feel you must use something other than water.

What about bleeding?
Bleeding helps clean out wounds. Most small cuts or scrapes will stop bleeding in a short time. Wounds on the face, head or mouth will sometimes bleed a lot because these areas are rich in blood vessels. To stop the bleeding, apply firm but gentle pressure on the cut with a clean cloth, tissue or piece of gauze. If the blood soaks through the gauze or cloth you're holding over the cut, don't take it off. Just put more gauze or another cloth on top of what you already have in place and apply more pressure. If your wound is on an arm or leg, raising it above your heart will also help slow the bleeding.

Should I use a bandage?
Leaving a wound uncovered helps it stay dry and helps it heal. If the wound isn't in an area that will get dirty or be rubbed by clothing, you don't have to cover it. If it's in an area that will get dirty (such as your hand) or be irritated by clothing (such as your knee), cover it with an adhesive strip or with sterile gauze and adhesive tape. Change the bandage each day to keep the
wound clean and dry.
Certain wounds, such as scrapes that cover a large area of the body, should be kept moist and clean to help reduce scarring and speed healing. Bandages used for this purpose are called occlusive or semiocclusive bandages. You can buy them in drug stores without a prescription. Your family doctor will tell you if he or she thinks this type of bandage is best for you.

Should I use an antibiotic ointment?
Antibiotic ointments help healing by keeping out infection and by keeping the wound clean and moist. A bandage does pretty much the same thing. If you have stitches, your doctor will tell you whether he or she wants you to use an antibiotic ointment. Most minor cuts and scrapes will heal just fine without antibiotic ointment, but it can speed healing and help reduce scarring.

What should I do about scabs?
Nothing. Scabs are the body's way of bandaging itself. They form to protect wounds from dirt. It's best to leave them alone and not pick at them. They will fall off by themselves when the time is right.

When should I call my doctor?
Call your doctor if your wound is deep, if you can't get the edges to stay together or if the edges are jagged. Your doctor may want to close your wound with stitches or skin adhesive. These things can help reduce the amount of scarring. You can close small cuts yourself with special tape, called butterfly tape, or special adhesive strips, such as Steri-Strips.

Taping a wound
Call your family doctor if any of the following things occur

• The wound is jagged.
• The wound is on your face.
• The edges of the cut gape open.
• The cut has dirt in it that won't come out.
• The cut becomes tender or inflamed.
• The cut drains a thick, creamy, grayish fluid.
• You start to run a temperature over 38�C.
• The area around the wound feels numb.
• You can't move comfortably.
• Red streaks form near the wound.
• It's a puncture wound or a deep cut and you haven't had a tetanus shot inthe past 5 years.
• The cut bleeds in spurts, blood soaks through the bandage or the bleedingdoesn't stop after 10 minutes of firm, direct pressure.
  

How do I take care of stitches?
You can usually wash an area that has been stitched in one to three days. Washing off dirt and the crust that may form around the stitches helps reduce scarring. If the wound drains clear yellow fluid, you may need to cover it.
Your doctor may suggest that you rinse the wound with water and rebandage it in 24 hours. Be sure to dry it well after washing. You may want to keep the wound elevated above your heart for the first day or two to help lessen swelling, reduce pain and speed healing.
Your doctor may also suggest using a small amount of antibiotic ointment to prevent infection. The ointment also keeps a heavy scab from forming and may reduce the size of a scar.
Stitches are usually removed in 3 to 14 days, depending on where the cut is located. Areas that move, such as over or around the joints, require more time to heal.

What is skin adhesive?
Skin adhesive is a new way to close small wounds. Your doctor will apply a liquid film to your wound and let it dry. The film holds the edges of your wound together. You can leave the film on your skin until it falls off (usually in 5 to 10 days).
It's important not to scratch or pick at the adhesive on your wound. If your doctor puts a bandage over the adhesive, you should be careful to keep the bandage dry. Your doctor will probably ask you to change the bandage every day.
Don't put any ointment, including antibiotic ointment, on your wound when the skin adhesive is in place. This could cause the adhesive to loosen and fall off too soon. You should also keep your wound out of direct light (such as sunlight or tanning booth lamps).
Keep an eye on your wound. If the skin around your wound becomes very red and warm to touch, or if the wound reopens, call your doctor.

Do I need a tetanus shot?
Tetanus is a serious infection you can get after a wound. The infection is also called "lockjaw," because stiffness of the jaw is the most frequent symptom.
To prevent tetanus infection when the wound is clean and minor, you'll need a tetanus shot if you haven't had at least three doses before or haven't had a dose in the last 10 years. When the wound is more serious, you'll need a tetanus shot if you haven't had at least 3 doses before or if you haven't had a shot in the last 5 years. The best way to avoid tetanus infection is to talk to your family doctor to make sure your shots are up to date.
(AAFP)