A Family Doctor's Tale - CUTS AND LACERATIONS

DOC I GOT A CUT

A cut or laceration  is an injury to the skin and its underlying soft tissue when you are cut or hit by something. 

A laceration is usually called a cut when the injury is caused by a sharp object breaking the skin. 
It may a clean cut without bleeding or if it damage the blood vessels in the skin, it can cause visible bleeding. 

Lacerations can occur at any part of the body.
Healing time for a laceration depends on where it is on your body.
A laceration usually take longer to heal if it is over a joint such as the knee or elbow.


1.Lacerations may appear in all shapes and sizes.
2.It may look like a cut, tear, or gash.
3.The wound may hurt, bleed, bruise, or swell.
4.Lacerations may bleed a lot in areas of the skin which has a lot of blood vessels such as the scalp.
5.The wound may have edges that are close together, or gaping apart. 
6.Sometimes there may be numbness around the wound due to a cut of the nerve endings.
7.Similarly there may be decreased movement in an area below the wound due to loss of nerve endings or tear of muscle fibres.


Even with proper treatment, a laceration can become infected:


1.Increased warmth to the area.
2.Redness or swelling to the area which becomes worse.
3.Pain in the area that increases over time.
4. pus or bad-smelling discharge from the wound.
 Pus is milky and may be white, yellow, green, or brown.
 It is the result of the white blood cells fighting the bacteria or virus.


 Other complications may be:
 1.the presence of foreign bodies
 2.Injury to the bone( fracture)
 3.Injury to the nerve
 4.Injury to the blood vessels
 5.Injury to muscles


If there is suspected foreign objects in your cut, an x-ray may be required. 
Foreign objects include things like metal, gravel, and glass.
If you have many wounds from a car accident, tests may include an ultrasound, a MRI, or a CT ("cat") scan.


The family doctor will want  to
1.control the bleeding if your wound is bleeding a lot.
2.clean your wound with disinfectant.
This will remove dirt and other small objects and reduce the chance of infection.
3.look in the wound for foreign objects like dust or glass splinters.
4.explore (probe) or close the wound under local anesthesia. 
An anesthetic is a medicine which numbs the area so that there is no pain during the probe or surgery.


Closing the wound:
The laceration may need stitches, staples, other treatments to close the wound:
if it is deep or bleeds a lot.
if your wound is gaping open or
if the wound is in an area that moves a lot, such as the hands, feet, and joints.
Stitches also keep the wound from getting infected.
Stitches may decrease the amount of scarring. 

If the wound is too old, it may not be stitched. 

Some lacerations may heal better without stitches.

New innovations such as surgical glue to close wounds, skin closure strips can close smaller and shallow cuts and lacerations without stitching. In the past we have children with cuts which are open and require closure for the wound to heal properly. 
Often the parents may be needed to grab the child while local anesthetic and stitching is done. Nowadays all you need is to clean the wound and a closure strip applied to the wound to close the wound. 
There is minimal trauma to the child.


If there are natural appendages like hair, they can be used like stitches to close small gaping wounds:


Recently I had a maid who had small gaping wound in the scalp. After cleaning the wound the hair is weaved around the wound to close the gaping wound. Usually the hairs do not need to be removed unlike the stitching of the wound.

Special care:
Some lacerations need special care.
Laceration caused by bits from fish or marine life may need special medicines like antibiotics and antitoxins.
Antibiotics are not needed for most wounds.
Antibiotics are given if your wound has a high risk of infection. 

If the laceration injure a bone, nerves, or blood vessels, there may be need to refer to hospital for microsurgery to join the torn nerve or blood vessel. 

A broken bone may also need to be treated conservatively or with surgery.


Tetanus injection:
Tetanus infection, or "lockjaw," can happen after any deep break in your skin. Tetanus (A Simple Guide to Tetanus)can kill you.
It is important for adults to get a tetanus shot at least every 10 years. 

After an injury, a tetanus injection may be given
1.if it has been longer than five years since your last one.
2.any wound that may have dirt or saliva (spit) in it.
3.Deep wounds also have a high risk for tetanus infection.
If necessary, tetanus shots should be given as soon as possible (within 72 hours of the injury).


A sharp object which passed through your clothing before cutting your skin may have caused small threads or bits of clothing to be pushed under your skin. The risk of getting an infection is higher if there are foreign bodies in the wound.


Sometime even with the best care, there may still problems such as infection with your wound.


People who have diabetes have a higher chance of getting a serious infection in a wound.