Cuts and puncture wounds

On sustaining an injury that leads to cuts and puncture wounds, immediate and delayed responses can occur.

Immediate responses can lead to symptoms such as:

• Bleeding: The bleeding may be minimal; however, larger cuts or puncture wounds involving soft tissues or blood vessels can result in significant blood loss.
• Swelling: The area surrounding the wound becomes swollen, inflamed, and tender to touch.
• Pain: The intensity of pain varies from mild to extremely severe, depending on the injury's severity and the structures involved.
• Difficulty in movement: Pain, swelling, and bleeding can make it difficult to move or bear weight on the injured area.

Delayed responses can lead to symptoms such as:

• Fever: An infected wound that has not healed can cause the body to respond with fever as it fights off the infection.
• Pus formation: This is common in infected wounds, where pus, a collection of dead white blood cells, accumulates due to ongoing infection.
• Chronic pain: Prolonged non-healing wounds can result in chronic pain.
• Infection: Factors such as contaminated wounds, the presence of foreign bodies, diabetes, reduced immunity, and unclean dressings can lead to infection.

Cuts and puncture wounds are 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 follows:

• Cuts: These injuries occur from clean, sharp-edged objects, such as knives and scissors, or as a result of blunt trauma, such as falling on a rocky surface or hitting the edges of furniture. These types of wounds typically have a larger surface area but are mostly superficial.
• Puncture wounds: These refer to injuries caused by 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 sharp objects like rocks, furniture, tools, or broken glass.
• Walking without proper footwear on open roads or grounds where nails or other sharp objects may be present.
• Not wearing protective gear while operating tools or heavy machinery.
• Automobile accidents.
• Self-infliction of injury.
• Surgical incisions.

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

• Age: Children and the elderly are more prone to cuts and puncture wounds. Children may be careless while playing outdoors, while the elderly may struggle with balance and coordination issues, making them more susceptible to falls and injuries.
• Movement disorders: Patients with movement disorders, such as Parkinson’s disease, cerebral palsy, and ataxia, are more prone to falls, thus increasing their risk of injury.
• Health conditions and low immunity: Diabetics are at a higher risk for wound complications. If a diabetic patient sustains cuts or puncture wounds, they are more likely to become infected, and healing may be delayed. Similarly, patients undergoing chemotherapy or those who have received an organ transplant are at risk for complications from simple cuts and puncture wounds due to their low immunity.
• Psychological illnesses: Individuals with certain psychological conditions, such as borderline personality disorder, depression, anxiety disorders, and post-traumatic stress disorder, may be more self-critical and engage in self-injury.

Common sites for cuts and puncture wounds

A few areas of the body are more prone to injuries than others:

• Cuts: Common sites include the forehead, knees, elbows, hands, fingers, and legs.
• Puncture wounds: Common sites include the toes, feet, legs, fingers, and hands.

Mild cuts and puncture wounds require no investigation and often heal on their own. However, if the injury is severe or does not heal properly, doctors may order several investigations to evaluate the situation in detail:

• Arterial and Venous Doppler of both lower limbs and upper limbs may be performed, depending on the site of injury in cases of puncture wounds with excessive blood loss to assess blood insufficiency.
• X-ray to detect any concurrent bony injuries. Tests may include X-ray of the right ankle (AP view), X-ray of the 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.
• Random Blood Glucose and Fasting Blood Glucose tests to check for sugar control in diabetic patients.
• Culture sensitivity testing to identify disease-causing microorganisms and determine which antibiotics are effective against the identified microorganisms. This is usually recommended in cases of severe infection.

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, or pieces of glass.
• 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. 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, or increased pain.

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.
• Using topical antiseptic ointments while covering the wound with proper dressing.
• Providing 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 reduce 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, and neosporin are used along with dressing to cover infected wounds.
• Vitamin C and zinc supplements to promote rapid wound healing.

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

• Monitor for any signs of infection, such as fever or pus discharge from the wound.
• Change dressings at regular intervals, at least once every day or more frequently if they become soiled.
• Wash hands thoroughly before tending to wounds.
• Use sterile bandages and antiseptic ointments only.
• Take ample rest; avoid unnecessary movement or undue pressure on the affected area.
• Maintain a balanced diet rich in vitamins and protein to facilitate faster healing.

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 that may spread to other parts of the body, such as bones, causing osteomyelitis.
• Formation of hypertrophic scars and keloids.
• Loss of mobility in the affected area.
• Diabetic foot in patients with unregulated blood glucose levels.
• Amputation of the affected body part in cases of severe untreated infection.
• Death due to excessive blood loss or from infection leading to septicemia.

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

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 can be applied topically as an ointment or used in the dressing as drops.

Minor cuts can be treated with simple home remedies; however, a puncture wound, being deeper, must always be treated by a doctor. Once bleeding is controlled, 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 control 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, or fever. If any of these occur, consult your doctor immediately.