Cuts and puncture wounds

Causes Of Cuts And Puncture Wounds

Cuts and puncture wounds are the injuries resulting from trauma caused by sharp objects. Such wounds damage the skin and cause a break in the continuity of the skin. More specifically, these can be described as below:

Cuts: These are the injuries occurring from clean, sharp-edged objects, such as knives, scissors, etc., or as a result of blunt trauma, such as an injury sustained after falling on a rocky surface, or hitting the edges of furniture, etc. These types of wounds typically have a larger surface area but are mostly superficial.

Puncture wounds: These refer to the injuries occurring from sharp objects, such as nails or needles. They typically have a smaller surface area but penetrate deeper.

Cuts and puncture wounds can occur in a variety of circumstances where a body part is at risk of sustaining an injury, such as: 

• Falling and hitting yourself on sharp objects like rocks, furniture, tools, broken glass, etc.
• Walking without proper footwear on open roads or grounds where nails or other sharp objects may be lying around
• Not wearing protective gear while operating tools or heavy machinery
• Automobile accidents
• Self-infliction of injury
• Surgical incisions

Symptoms Of Cuts And Puncture Wounds

On sustaining an injury that leads to cuts and puncture wounds, immediate response and delayed response can take place.

Immediate responses can lead to symptoms such as:

• Bleeding: At times, the bleeding can be minimal. In the case of larger cuts or puncture wounds or where soft tissues or blood vessels are also injured, there may be significant blood loss.
• Swelling: The area surrounding the wound becomes swollen, inflamed, and tender to touch.
• Pain: Depending on the severity of an injury and the structures involved, the intensity of pain ranges from mild to extremely severe.
• Difficulty in movement: Due to pain, swelling and bleeding, it becomes difficult to move or bear weight on the area injured.

Delayed responses can lead to symptoms such as:

• Fever: If a wound that has not healed for long becomes infected, the body tries to fight off the infection, resulting in fever.
• Pus formation: It is a common occurrence in infected wounds. Pus refers to a collection of dead white blood cells that accumulate in the wound due to an ongoing infection.
• Chronic pain: Wounds that do not heal for a long time can cause chronic pain.
• Infection: Contaminated wounds, presence of foreign bodies in the wounds, diabetes, reduced immunity, and unclean dressings can lead to a wound being infected.

Risk Factors For Cuts And Puncture Wounds

Although injuries can happen to anyone at any point in time, certain factors increase the chances of complications and serious injuries. These factors include:

Age: Children and elderly are more prone to cuts and puncture wounds. While children are often careless while playing outdoors, elderly may struggle with balance and coordination issues. They may also be more prone to falls. Hence, have a higher risk of sustaining cuts and puncture wounds.

Movement disorders: Patients suffering from movement disorders, such as Parkinson’s disease, cerebral palsy, ataxia, etc., are more prone to falls, thus having a higher risk of injuries.

Health conditions & low immunity: Diabetics are more prone to wound complications. If a diabetic patient sustains cuts and puncture wounds, it is more likely to get infected and healing may be delayed. Similarly, patients on chemotherapy or those who have got an organ transplant are prone to complications arising from simple cuts and puncture wounds because of their low immunity.

Psychological illnesses: People with certain psychological conditions such as borderline personality disorder, depression, anxiety disorders and post-traumatic stress disorder are more likely to be self-critical and thereby engage in self-injury.

Common sites for cuts and puncture wounds

A few areas in the body are more prone to injuries than others.

• Cuts: The common sites of injuries include forehead, knees, elbows, hands, fingers and legs.
• Puncture wounds: The common sites of injuries include toes, feet, legs, fingers and hands.

Diagnosis Of Cuts And Puncture Wounds

Mild cuts and puncture wounds need no investigation and often heal on their own. If the injury is severe or does not heal appropriately, doctors may order a few investigations/tests to evaluate in detail: 

• Arterial and Venous Doppler Both Lower Limb, Arterial and Venous Doppler Both Upper Limb may be performed, depending on the site of injury in the case of puncture wounds with excessive blood loss to determine the blood insufficiency.

• X-ray to detect if a concurrent bony injury has occurred. Tests may include X-ray Right Ankle AP View, X-Ray Left Elbow AP View, etc.

• Complete Blood Count (CBC), Erythrocyte Sedimentation Rate, Total Leukocyte Count (TLC) and Differential Leukocyte Count (DLC) in cases of suspected wound infection.

• Glucose - Random Blood, Glucose - Fasting Blood to check for sugar control in diabetic patients. 

• Culture sensitivity testing refers to identification of disease-causing microorganism, and to determine which antibiotics are sensitive to (effective against) the identified microorganism. It is usually recommended in case of severe infection.

Specialist To Visit

Seek medical care if cuts and puncture wounds cannot be managed by first aid in the following situations: 

• Excessive bleeding, spurting or bleeding that does not stop even after 10 minutes of applying pressure

• Very deep puncture wounds

• Presence of foreign bodies deep inside the wound

• Excessive pain

• Inability to move parts surrounding the wound

Medical care is also required in cases where the wound gets infected after primary care at home. Signs of infection include: 

• Pus formation or discharge from the wound

• Foul-smelling wounds

• Fever

• Increased redness and warmth around the wound

• Increased pain

Doctors to consult in such situations: 

• General physician
• Emergency department physician
• Orthopedic and Trauma surgeon
• Dermatologist

Treatment Of Cuts And Puncture Wounds

The treatment of cuts and puncture wounds depends on whether emergency care is essential or care for complicated wounds is required.

1. First-aid for cuts and puncture wounds

Whenever an injury occurs, it is essential to administer basic first aid to the cuts and puncture wounds. After administering first aid, the decision may be made whether the wound can be managed at home or needs treatment by a doctor, depending on the severity of the wound.

The pointers given below should be followed when you administer basic first aid: 

• Inspect the wound thoroughly and look for the presence of any foreign body, such as dirt, tin, stones, pieces of glass, etc.
• Carefully remove the foreign body if it is superficial, ensuring it does not increase the bleeding. If the foreign body is deeply embedded in the wound, do not try to remove it. Seek medical help.
• Assess the amount of bleeding and if the bleeding is excessive, immediately call for help.
• Try to stop the bleeding by applying pressure to the area and holding the area in an elevated position if possible.
• Once the bleeding is under control, gently but thoroughly clean the wound with an antiseptic liquid or sterile water.
• Apply a topical antiseptic cream and cover the area with a sterile bandage dressing.
• Inspect the dressing regularly to see if it gets soiled or wet, and change it as required.
• Monitor for signs of infection, such as fever, discharge from the wound, increased pain, etc.

2. Emergency treatment of cuts and puncture wounds

Emergency treatment consists of: 

• Stopping the bleeding. If the patient has lost excessive blood, intravenous transfusions with normal saline infusion or blood transfusion may be required.

• Surgical debridement and cleaning the wound in the case of heavily contaminated wounds, with extensive damage to surrounding soft tissues.

• Suturing the wound.

• Use topical antiseptic ointments while covering the wound with proper dressing

• Appropriate additional treatment for concomitant injuries.

• Tetanus toxoid TF injection is given if the patient has not taken a dose in the last 5 years.

• Painkillers, antibiotics and anti-inflammatory medicines are recommended to relieve pain, prevent infection and inflammation respectively.

3. Treatment for complicated cuts and puncture wounds

If the wounds become infected, additional treatment to control the infection and promote healing is required. 

• Paracetamol for relief from pain and fever.

• Antibiotics like amoxicillin, cotrimoxazole, ampicillin, azithromycin, and doxycycline can be given to prevent bacterial infection

• Antibacterial ointments like soframycin, mupirocin, neosporin, etc are used along with dressing to cover infected wounds

• Vitamin C and zinc supplements to promote rapid wound healing.

Home-care For Cuts And Puncture Wounds

After appropriate first aid of cuts and puncture wounds, it is essential to take utmost care for faster healing without complications. 

• Keep a close tab on any signs of infection such as fever or pus discharge from the wound.
• Change dressings at regular intervals. Once every day or more frequently if they get soiled.
• Wash hands thoroughly before tending to wounds.
• Use sterile bandages and antiseptic ointments only.
• Take ample rest. Do not move the part unnecessarily or exert undue pressure.
• Take a balanced diet rich in vitamins and protein to facilitate faster healing.

Complications Of Cuts And Puncture Wounds

If cuts and puncture wounds are left untreated, they may result in a variety of complications, such as: 

• Excessive blood loss, leading to hypotension and vascular shock.
• Chronic wound infection may spread to other parts of the body, such as bones, and cause osteomyelitis.
• Formation of ugly hypertrophic scars and keloids.
• Loss of mobility in the affected area.
• Diabetic foot in patients with unregulated blood glucose levels.
• Amputation of the body part in case of severe untreated infection.
• Death due to excessive blood loss or from infection leading to septicemia.

Alternative Therapies for Cuts And Puncture Wounds

There are not many alternative therapies that can effectively treat cuts and puncture wounds. Standard medical care remains the most effective choice in treating cuts and puncture wounds.

Certain alternative medicine forms are available and have been found to be effective in promoting rapid wound healing. These may include homeopathic preparations such as Calendula Officinalis which is applied topically as an ointment or used in the dressing as drops.

Minor cuts can be treated with simple home remedies, but a puncture wound, as it is deep, must always be treated by a doctor. Once bleeding is arrested, gently clean the area with a cotton swab dipped in antiseptic dilution. You can apply an antiseptic ointment like soframycin or even turmeric over the wound. Turmeric is an excellent antiseptic agent and can also help arrest bleeding. 
Keep the wound covered with a clean sterile bandage or leave it open after antiseptic application.

REMEMBER! Monitor for signs of infection such as increased swelling, pain, fever, etc. and if they occur, consult your doctor immediately.