A ‘laceration’ is our fancy medical term for a cut or tear in the skin, and a good reason for a patient to come to the emergency department (ED). Prompt wound care is important to prevent infection and promote healthy healing, and so we wanted to offer some tips on what to do when that kitchen knife develops an attitude. Or when your toddler hasn’t yet learned to not look to the left and then run to the right. Or when two beers inspire you to take on that long-awaited woodworking project.
What to do immediately when the cut happens . . .
Some of the most important steps in wound care happen before you even come to the ER. If you cut yourself, there are two main objectives: stop the bleeding, and wash out the cut. First and foremost, stop the bleeding. This is best done by providing direct pressure on the area that is bleeding, with a finger or hand (layering a clean bandage or gauze between the two is never a bad idea). Typically the bleeding stops with a few minutes of direct pressure, but injuries to larger blood vessels or patients whose blood doesn’t clot normally (either from a medical condition or blood-thinning medications) may have bleeding that is difficult to control.
If you can control the bleeding, then the next best step is to run the cut under water for several minutes. This is the best way to clean a wound and does not require sterile or medical-grade supplies. Simple tap water works just as well, and perhaps even better because it provides a steady source of irrigation. This will effectively wash away most of the bacteria that enters the skin when the accident happens. It is normal for this part to cause some re-bleeding, as some of that healthy blood clot will get washed away along with the harmful bacteria. As long as the bleeding is relatively well controlled, keep on washing! Cold water is best, as it will help constrict the blood vessels and stop any ongoing bleeding. It is even better if you can handle the sting and throw some soap on there but avoid hydrogen peroxide. It kills the happy healthy skin cells that are waiting for the opportunity to regrow.
If you can’t control the bleeding, it is best to consider rapid transport to the ER. This is especially true if you are quickly soaking through heavy bandages and the bleeding is not slowing down. Please consider calling 911 under the following circumstances:
- You are bleeding heavily and you have no one to safely transport you to the ER
- The blood coming from your cut is ‘pulsatile’ (large, or projectile gushes of blood that follow a similar rhythm to a heartbeat), and thus suggestive of damage to the artery. You are particularly at risk for this with a cut to the neck or joints – armpits, inside of the elbows and wrists, groins, and back of the knee. Don’t bother with trying to fashion a homemade tourniquet, they are not effective. Have someone apply direct pressure and call 911.
- You are pale, dizzy, confused or tired, or lose consciousness
Okay so I am not bleeding to death, do I still need to go to the ER?
Provided the bleeding is controlled and the wound is irrigated thoroughly at home, patients often question whether an emergency room trip is necessary. While cuts are rarely life-threatening, delayed wound care brings a high risk of infection, which can often cause worse damage than the cut itself.
If the top layer of skin is cut, and certainly if there is a gap between the edge of the skin, most often some type of wound closure is needed (whether it be stitches, staples, or our super special medical-grade super glue). Delaying care is not advised, both because it increases the risk of infection, leads to delayed healing, and sometimes excludes our ability to close the wound if it has been over 24 hours since the event. So if you think you may need stitches, you probably do . . .
So you got stitches or staples, what’s next?
After you leave the ED with newly repaired skin (yay!), you are well on your way to healing but need to take good care of the area to prevent infection. Here’s how to do it:
- Keep the area dry as possible for the first 24 hours. This means no hot tubs, slip n’ slides, or hot yoga. If you have absorbable sutures (stitches that slowly dissolve and do not have to be removed), it is best to keep it dry for 48 hours.
- A note on showers: as doctors, we generally endorse good hygiene. Go ahead and shower, doing your best to keep the affected area dry. If your cut is on your head or scalp, this typically leaves some dried blood in your hair, and so showering when you get home is expected. Just be sure to minimize your time in the shower and pat dry immediately afterward.
- After your 24-48 dry period, you can get the area wet, but don’t immerse the wound in water (This means still no hot tubs. Slip and slides are still ill-advised). It is actually a good idea to let soap and water run over the area a couple of times a day to keep it clean, as you would in a shower, but do not vigorously rub or clean the area. Young skin cells are hard at work and require a gentle touch.
- After you get the area wet, pat the skin dry, and if possible, leave it exposed to the air for an hour or so (provided you are in a clean environment, like your living room). Skin loves oxygen and fresh air just as much as our other organs.
- For the most part, keep the area covered to prevent dirt and bacteria from getting into the wound. You can also consider applying a light layer of antibacterial ointment (that can be purchased over the counter) twice a day in the first 48 hours, but it is not needed beyond the first couple days.
Stitches and Staple Removal
Most stitches are not absorbable and need to be removed, as do all staples. The length of time they should remain in place depends on the cut and the location, but typically they get removed after a week (your ED clinician will tell you how many days they need to stay in). A general practitioner or primary care provider can remove them, but if you are unable to see your regular doctor, patients are always welcome to return to the emergency room to have them removed. An urgent care is also an option.
How do I know if the wound is getting infected?
If you start to notice signs of infection, it is best not to wait for your follow up appointment, but instead seek immediate medical evaluation for consideration of antibiotics. A little bit of redness and swelling is expected in the early stages as the wound heals. If you develop any of the followings signs or symptoms, however, be sure to have the area evaluated by a clinician:
- Increasing or rapidly progressing redness, particularly if the redness around the area initially improved.
- Increasing pain or swelling.
- Pus-like drainage from the area (note that ‘scabbing’ tissue can sometimes have a whitish appearance to it, such as the way a scab looks when it gets wet, but if the wound has active or steady drainage from it, or smells foul, those are bad signs).
- If your body starts to feel the way it does when coming down with an infection cold, such as fever, body aches, loss of appetite or energy.
When it comes to an initial evaluation of a cut, or concern for infection down the line, it is best not to delay care. The most feared complication of a laceration is an infection, and can have significant consequences (not just for the area itself, but someone’s overall health). When in doubt, we are always happy to help you out at your nearest emergency room!