- First Aid
What Are Cuts or Lacerations?
- A cut refers to a skin wound with separation of the connective tissue elements. Unlike an abrasion (a wound caused by friction or scraping), none of the skin is missing the skin is just separated. A cut is typically thought of like a wound caused by a sharp object (such as a knife or a shard of glass).
- The term laceration implies a torn or jagged wound. Lacerations tend to be caused by sharp objects. Cuts and lacerations are terms for the same condition.
- The term gash can be used for more dramatic effect because it implies a longer or deeper cut.
- An avulsion refers to a wound where tissue is not just separated but torn away from the body.
- After you suffer a cut you often bleed. Other concerns with a cut include infection, pain, damage to structures beneath the skin, and future scars.
What Are Symptoms and Signs of Cuts or Lacerations?
- Although it can be obscured by blood, a cut is one of the easiest medical conditions to diagnose.
- A deep cut may reveal underlying tissues such as fat, tendon, muscle, or bone.
- Some people faint at the sight of their own blood (this is a neurological reaction in which a reflex slowing of the heart causes a low blood pressure called vasovagal syncope). Physicians need to distinguish this common faint from people who pass out from loss of blood (hemorrhagic shock).
When to Seek Medical Care for Cuts or Lacerations
Call your doctor to decide whether you need a tetanus booster. You should have had a tetanus booster immunization within the last 10 years if you have a simple, clean cut, or within the last five years if you have a more complex or dirty cut.
Beyond general wound care advice, it is very difficult to give advice on care specific to a patient's cut over the phone. Your doctor may help you decide whether it is better to go to the doctor's office or to a hospital's Emergency Department.
Ask these questions when considering whether to get treatment for a cut at a hospital's Emergency Department:
- Can you stop the bleeding?
- Are the wound edges separated?
- Can you adequately clean the wound?
- Is it possible that serious underlying damage was done (such as a cut nerve or tendon)?
- Do you need tetanus or rabies shot?
What Exams and Tests Assess Cuts and Lacerations?
Your doctor will assess your cut by first taking a history. You should know the following facts:
- When it happened
- How it happened
- Any problems, weakness or numbness you notice (such as if you can't move or feel a finger after a cut on the hand)
- Any pre-existing medical conditions (if you have circulation problems or diabetes, you may require additional treatment to prevent infection)
Physical exam will include the following:
- Separating the edges and looking at the wound
- Testing nerve, artery, and muscle function
- Checking for objects in the cut (such as embedded glass or wood)
- Examining your overall condition (such as whether you are pale from blood loss or anxiety)
An x-ray may be ordered if foreign objects or an underlying broken bone is suspected.
What Are First-Aid Tips and Home Remedies for Cuts and Lacerations?
- Most bleeding can be stopped with direct pressure and time (rest and elevation are also helpful).
- Cleaning with a gentle soap and water will help reduce the chance of bacterial infection.
- Antibiotic ointment (such as bacitracin) and a sterile gauze bandage will help to protect the wound from further infection and water loss until a scab forms.
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What Are Medical Treatments for Cuts or Lacerations?
Just as at home, the first step is to stop the bleeding.
- If the direct pressure is not enough, a blood pressure cuff can help as a temporary measure for cuts on arms and legs.
- Tourniquets are generally not helpful for cuts to the face or body.
Medication to numb the area may be given. Depending on the size and location of the cut, this may be done using various methods:
- Topical medicine
- Direct injection of anesthetic into the wound
- Injection into a regional nerve - called "nerve block" - (for cuts to the fingertip, the nerves at the finger base are often blocked with a series of shots)
Cleaning is the most important aspect of good wound care.
- This may be done by first washing the adjacent skin with soap and water and removing crusted blood with diluted hydrogen peroxide.
- Next, irrigation by squirting saline at the wound under high pressure is very effective at reducing bacterial contamination in the wound.
Your doctor will decide the best way to repair your wound.
- Some minor cuts can be closed with special adhesive tapes (Steri-Strips) or tissue glue (Dermabond or Indermil). Tissue glue can be used as a barrier against common bacterial microbes. Be sure to inform the doctor if you have any allergies to these adhesive tapes.
- Deeper cuts may need stitches to repair deep structures (such as fascia, the connective tissue envelope around a muscle).
- Stitches to the skin surface can help to stop bleeding, protect underlying tissues, and lessen scarring.
Different bandages are chosen for their different material properties.
- Some materials are better because they won't stick to your cut (Telfa or Vaseline gauze).
- Others are more absorbent, provide needed surface pressure, or help to keep an injury immobile. Pressure bandages or splints may be applied, depending on the underlying injuries.
Next Steps After Cut or Laceration Care
A wound check without suture removal may be recommended after one or two days, especially if the chance of infection is thought to be higher than the usual 5%, or if changing the bandage may be difficult.
Follow-up for Cuts and Lacerations
Removal of your stitches is usually done at your doctor's office after 4-14 days.
- Facial stitches may be removed after four days and no later than seven days, because healing occurs faster in this location of the body, and additional scarring from the stitches is a bigger concern.
- Sutures in your hand may be left in 14 or more days because of slower healing and greater tension on the wound.
- The doctor who placed the stitches will often recommend the number of days before this follow-up.
Be gentle with a healing cut for the first six weeks. It takes that long for a wound to achieve about 80% of its final healed strength.
How Can People Prevent Cuts and Lacerations?
- The bottom line is to use common sense. In a perfect world of preventive medicine, people would not get into fights, shoes would always be worn outside, glass doors would not exist, the left hand would not be used as a cutting board, lawn mowers would be turned off before removing jammed material, and people would always wear seat belts.
- If all this occurred, Emergency Departments would see far fewer cuts.
What Is the Prognosis for a Cut or Laceration?
Infection is the biggest medical concern in the first few weeks.
- Signs of infection include severe pain, draining pus, redness beyond the wound edges, fever and chills, or excessive wound swelling.
- Inflammation from wound healing and stitches can cause minor redness around the wound edges and is normal.
- If you think you might have an infection, see a doctor.
Scarring is a big concern. Although good wound care gives the best chance of a smaller scar, there are several factors you can't control:
- Some African American people form keloid scars during the healing process
- A keloid is a thick swollen scar with a ropelike quality.
- Sometimes a dermatologist or plastic surgeon can treat the condition after the wound is healed.
- More jagged cuts with more traumatic skin damage (such as a cut surrounded by an area of abrasion) tend to scar more.
- Cuts in the same direction as your natural skin lines (wrinkle lines) are less visible.
There are some things you can do to help minimize the possibility of scarring:
- Infected wounds tend to scar more.
- Keep an eye out for redness, swelling, or other signs of infection and see a doctor if these occur.
- Keep the wound covered and clean while healing.
- Avoid sun exposure, as newly healed tissue burns more easily and is often left discolored.
- Over-the-counter scar creams are generally not harmful but they have not been proven to be effective.
- It is important to realize that a scar will often look red and swollen after suture removal but may fade considerably for up to one year. You might want to wait at least that long before consulting a specialist for scar revision.
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Armstrong, David G., and Andrew J. Meyr. "Basic principles of wound management." UpToDate.com. Apr. 28, 2016. <http://www.uptodate.com/contents/basic-principles-of-wound-management>.