Cuts, Scrapes and Small Wounds

Cleanliness is of first importance in preventing infection and helping wounds to heal.

To treat a wound . . .

First, wash your hands very well with soap and water.

If the wound is bleeding or oozing, wear gloves or plastic bags on your hands. Wash the skin around the wound with soap and cool, boiled water.

Now wash the wound well with cool, boiled water (and soap, if the wound has a lot of dirt in it. Soap helps clean but can damage the flesh).

When cleaning the wound, be careful to clean out all the dirt. Lift up and clean under any flaps of skin. You can use clean tweezers, or a clean cloth or gauze, to remove bits of dirt, but always boil them first to be sure they are sterile.

If possible, squirt out the wound with cool boiled water in a syringe or suction bulb.

Any bit of dirt that is left in a wound can cause an infection.

After the wound has been cleaned, apply a thin layer of antibiotic cream like Neosporin if you have it. Then place a piece of clean gauze or cloth over the top. It should be light enough so that the air can get to the wound and help it to heal. Change the gauze or cloth every day and look for signs of infection (see p. 88).

If you have a dirty wound or a puncture wound, and have never had a tetanus immunization, get one within 2 days.

NEVER put animal or human feces or mud on a wound. These can cause dangerous infections, such as tetanus.

NEVER put alcohol, tincture of iodine, or Merthiolate directly into a wound; doing so will damage the flesh and make healing slower.

LARGE CUTS: HOW TO CLOSE THEM

A recent cut that is very clean will heal faster if you bring the edges together so the cut stays closed.

Close a deep cut only if all of the following are true:

• the cut is less than 12 hours old,
• the cut is very clean, and
• it is impossible to get a health worker to close it the same day.

Before closing the cut, wash it very well with cool, boiled water (and soap, if the wound is dirty). If possible, squirt it out with a syringe and water. Be absolutely sure that no dirt or soap is left hidden in the cut.

There are two methods to close a cut:

1) BUTTERFLY 

2) BANDAGES OF ADHESIVE TAPE

STITCHES OR SUTURES WITH THREAD

To find out if a cut needs stitches see if the edges of the skin come together by themselves. If they do, usually no stitches are needed.

To stitch a wound:

• Boil a sewing needle and a thin thread (nylon or silk is best) for 20 minutes.
• Wash the wound with cool, boiled water, as has been described.
• Wash your hands very well with boiled water and soap.
• Sew the wound like this:

HOW TO TIE A GOOD KNOT

Make the first stitch in the middle of the cut, and tie it closed (1. and 2.).

If the skin is tough, hold the needle with a pair of pliers (or needle holder) that has been boiled.

Make enough other stitches to close the whole cut (3.).

Leave the stitches in place for 5 to 14 days (on the face 5 days; the body 10 days; the hand or foot 14 days). Then remove the stitches: cut the thread on one side of the knot and pull the knot until the thread comes out.

WARNING: Only close wounds that are very clean and less than 12 hours old. Old, dirty, or infected wounds must be left open. Bites from people, dogs, pigs, or other animals should also be left open. Closing these can cause dangerous infections.

If the wound that has been closed shows any signs of infection, remove the stitches immediately and leave the wound open.

BANDAGES

Bandages are used to help keep wounds clean. For this reason, bandages or pieces of cloth used to cover wounds must always be clean themselves. Cloth used for bandages should be washed and then dried with an iron or in the sun, in a clean, dust free place.

Make sure the wound has first been cleaned. If possible, cover the wound with a sterile gauze pad before bandaging. These pads are often sold in sealed envelopes in pharmacies.

Or prepare your own sterile gauze or cloth. Wrap it in thick paper, seal it with tape, and bake it for 20 minutes in an oven. Putting a pan of water in the oven under the cloth will keep it from charring.

It is better to have no bandage at all than one that is dirty or wet.

If a bandage gets wet or dirt gets under it, take the bandage off, wash the cut again, and put on a clean bandage. Change the bandage every day.

Examples of bandages:

Note: For children it is often better to bandage the whole hand or foot instead of one finger or toe. The bandage will not come off as easily.

CAUTION:

Be careful that a bandage that goes around a limb is not so tight it cuts off the flow of blood.

Many small scrapes and cuts do not need bandages. They heal best if washed with soap and water and left open to the air. The most important thing is to keep them clean.

INFECTED WOUNDS: HOW TO RECOGNIZE AND TREAT THEM

A wound is infected if:

• it becomes red, swollen, hot, and painful,
• it has pus,
• or if it begins to smell bad.

The infection is spreading to other parts of the body if:

• it causes fever,
• there is a red line above the wound,
• or if the lymph nodes become swollen and tender. Lymph nodes often called glands  are little traps for germs that form small lumps under the skin when they get infected.

Treatment of infected wounds:

• Put hot compresses over the wound for 20 minutes 4 times a day. Or hold an infected hand or foot in a bucket of hot water.
• Keep the infected part at rest and elevated (raised above the level of the heart).
• If the infection is severe or if the person has not been vaccinated against tetanus, use an antibiotic like penicillin.

WARNING: If the wound has a bad smell, if brown or gray liquid oozes out, or if the skin around it turns black and forms air bubbles or blisters, this may be gangrene. Seek medical help fast. Meanwhile, follow the instructions for gangrene.

WOUNDS THAT ARE LIKELY TO BECOME DANGEROUSLY INFECTED

These wounds are most likely to become dangerously infected:

• dirty wounds, or wounds made with dirty objects
• puncture wounds and other deep wounds that do not bleed much
• wounds made where animals are kept: in corrals, pig pens, etc.
• large wounds with severe mashing or bruising
• bites, especially from pigs, dogs, or people
• bullet wounds

Special care for this type of high risk wound:

1.  Wash the wound well with boiled water and soap. Remove all pieces of dirt, blood clots, and dead or badly damaged flesh. Squirt out the dirt using a syringe or suction bulb.

2.  If the wound is very deep, if it is a bite, or if there is a chance that it still has dirt in it, give an antibiotic such as ceftriaxone, or another cephalosporin for 3 to 7 days. If you do not have this type of medicine, give erythromycin, sulfamethoxazole with trimethoprim, or a sulfa drug.

3.  Never close this type of wound with stitches or butterfly bandages. Leave the wound open. If it is very large, a skilled health worker or a doctor may be able to close it later.

The danger of tetanus is very great in people who have not been vaccinated against this deadly disease. To lower the risk, a person who has not been vaccinated against tetanus should take penicillin or ampicillin immediately after receiving a wound of this type, even if the injury is small.

If the wound of this type is very severe, a person who has not been vaccinated against tetanus should take large doses of penicillin or ampicillin for a week or more. An antitoxin for tetanus should also be considered but be sure to take precautions if using tetanus antitoxin made from horse serum.

If the wound is from an animal bite and there is a chance of rabies, get an immunization right away.