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Don’t take wounds lightly

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We have all sustained open wounds, which are breaks in the integrity of the skin, but wounds can be closed as well. Closed wounds are caused by blunt force trauma, such as being punched or hit by a ball. The skin can be intact on the outside, but the impact can cause damage to the blood vessels under the skin, resulting in a bruise, or contusion, or even injury to internal organs.

Traumatic injuries can cause something as simple as a little discomfort all the way up to serious internal bleeding and death. A gushing head wound can be a terrifying sight but is usually easily repaired. Skin can be pulled together with stitches or staples and blood washed away, but the invisible damage to the brain, not always immediately apparent, can cause serious problems.

I talked about lacerations, which are open wounds, in my last article [“Wound care: Do I need stitches?;” July 26] but there is one type of laceration I didn’t mention, and that is an avulsion laceration, or as we used to call it in the ER, a “flap lac.” This is when a layer of skin, tissue, muscle, tendon, or bone tears away from the body. It can be a complete avulsion, as in cutting the tip of your finger off, or a partial one, leaving a flap of skin. Bleeding is sometimes hard to control with avulsions, so after you clean the wound, apply firm pressure with a clean cloth or gauze to stop the bleeding. Sometimes oozing of blood continues, and if you can’t stop it, go to the ED so it can be evaluated. More serious avulsions can result from violent injuries such as explosions or motor vehicle accidents.

There are other types of open wounds in addition to lacerations. An abrasion occurs when a part of the body scrapes across a rough or hard surface. Abrasions may not always be serious, but there are a lot of little nerve endings directly under the skin that are traumatized when the top layer of skin, or epidermis, is scraped away… and they can hurt. In the case of road rash, which is sustained when someone is thrown from a car or motorcycle and body surfs down the road after the vehicle has stopped moving, debris can become embedded in the wound and can be quite painful to clean. In the Emergency Room, at least in my time, we had the luxury of topical lidocaine to take the edge off the scrubbing, but home care may be a bit more challenging. The bottom line: all the dirt and debris must be removed.

A puncture wound is a hole made into the skin, usually by a long, pointed object such as a nail or needle, but can even be made by a bullet. Obviously, there can be many levels of injury with puncture wounds, and although they don’t always look bad on the outside, if the object is long or the force and velocity are great, there may be more serious injuries deep beneath the surface. If it’s dirty, it is likely to carry bacteria right along with it into the wound.

Neither open nor closed wounds should be taken lightly. If not cared for properly, even the smallest break in the skin can result in a devastating infection. If you have any doubt, go to the hospital. Next up: how to care for wounds at home.

Patricia Schoch is originally from Bethlehem, Pennsylvania but has lived in North Carolina for 30 years. A retired nurse, children’s book author, and freelance writer, she now resides in Wake Forest. Pat can be reached at Website: