Wound Care – Cuts and Grazes

Skin
Skin is made up of different layers and substances like collagen which make it both supple and tough and allow it to stretch and move without always tearing or breaking. But sometimes skin is broken.

Skin Damage – Cuts and Grazes
A graze is when the outer layer of skin is broken by being scraped or worn off. Thin-skinned bony areas – knees, elbows and ankles, are more likely to be grazed than thicker padded areas.

Cuts or incisions are caused by sharp objects such as a knife or piece of glass slicing into the skin. Depending on how deep a cut is and where it is on the body, there may be damage to blood vessels or nerves causing significant bleeding or other problems.

Simple cuts and grazes can be handled at home without treatment from a doctor.  Following some simple steps will help to limit the risk of infection and ensure proper healing with minimal scarring.

Treatment
First-aid for cuts and grazes includes:

1. Wash your hands
Whenever blood or other body fluids are around, the first thing to do is to wash your own hands. When possible put on surgical gloves to prevent cross-infection from diseases such as hepatitis that are transmitted by blood or other body fluids. If the person is unknown to you and gloves aren’t available, use plastic bags over your hands.

2. Stop bleeding
Most simple cuts will stop bleeding themselves. To help stop bleeding and especially for deep cuts:

• Apply pressure
• If a first-aid kit is handy, place a gauze swab or sterile dressing on top of the cut and press firmly to hold it in place for several minutes. If there isn’t a first-aid kit nearby, make do with a clean towel or a piece of clothing
• Raise the injured arm or leg above the level of the heart.

If bleeding continues, don’t remove blood-soaked dressings but keep putting new ones on top of each other and renew the pressure.

If bleeding is very heavy or doesn’t stop after 15 to 20 minutes, take the person to a doctor or dial 111 for an ambulance.

3. Clean the wound

• Rinse a wound with sterile normal saline solution – you can buy small ampoules of saline from a pharmacy to keep in a first aid kit. Use these to squirt saline over a wound
• If saline isn’t available, use clean tap water
• If a graze has dirt or gravel in it use a surfactant cleansing product to help remove it. Clean tweezers can be used to remove surface debris but if anything is embedded in the wound see a doctor
• Wipe from the centre of the wound to the outside using a clean piece of gauze or cloth each time
• Avoid using materials such as cotton wool from which small pieces of cotton may fall off and stay in the wound
• Clean the skin around a wound also
• Thorough wound cleaning reduces the risk of infection and tetanus.

4. Cover the wound
Covering a wound helps to keep it clean and provides protection.
We used to believe that letting a wound dry out and form a scab was best. We know now that scabs don’t promote healing but can delay it and cause scarring. A wound that remains moist heals faster. New dressings available now promote moist wound healing as they cover a wound and keep it at constant, body temperature. A pharmacist can help you choose a suitable dressing.

It is also now recommended that wounds are left undisturbed as much as possible during the healing process. This may mean leaving a dressing in place for 5 to 7 days rather than being changed daily. Some dressings are see-through so that you can keep an eye on a wound during the healing process.

5. Watch for signs of infection
Watch any wound for signs of infection. Things to look for include:

• Redness, swelling or heat
• Pus or thick, green or yellow fluid
• Red streaks under the skin, reaching out from the injury
• Fever
• Any wound that doesn’t start to heal.

See a doctor if you notice any signs of infection.

Not all wounds can be dealt with at home. As well as watching for infection, other reasons to see a doctor include if:

• You can’t stop bleeding
• There is an object in a wound you can’t remove
• A wound is deeper than say 0.5 cm, longer than 2.5 cm or has rough, jagged edges
• There is loss of function, eg. the person can’t bend an injured finger
• The wound was caused by a nail or other dirty object or by an animal bite. These wounds are at high risk of developing infection and a tetanus booster may be necessary.