Puncture Wound – Types, First aid and Treatment

Definition

Puncture wound is a deep wound made by a sharp object, such as a nail or a jagged piece of metal or wood. Puncture wounds may be small and not seem serious. But they do need to be treated by a healthcare provider.

Puncture wounds may become infected easily. This is because dirt and germs are carried deep into the tissues. Sometimes infection may be delayed, so it’s very important to have your child see a healthcare provider for any puncture wound. Foot wounds that happen from punctures with objects found outside have a high risk for infection. Wounds that penetrate through a shoe can be contaminated with sock and shoe particles. In some cases, a piece of the object that punctured your child can break off and remain under their skin. Infections with bacteria that can cause long-term bone infections also happen often.

First aid for puncture wounds

• Apply pressure with a clean cloth or bandage for several minutes to stop bleeding. If the bleeding is profuse, hold pressure for five to 10 minutes without stopping to look at the cut. If the cloth becomes soaked with blood, put a new cloth on top of the old one. Do not lift the original cloth.
• Once bleeding has stopped, wash your hands and then wash the area well with soap and water, but do not scrub the wound. Remove any dirt particles from the area and let the water from the faucet run over it for several minutes.
• Cover the area with an adhesive bandage or gauze.
• Call your child’s doctor, or if bleeding is severe, call 911 or take your child to the emergency room for further care.

Types of Puncture wound

Needle stick: if the wound is from a used or discarded needle, call a doctor right away. In some cases, medicines need to be started to stop the spread of infections like HIV/AIDS or hepatitis.

Foot Punctures: punctures into the bottom of the foot have a 4% risk of infection. This risk is higher in people with puncture wounds that go through a shoe. Pain lasting 4-5 days after the injury may be a sign of infection.

Pencil Lead Punctures: pencil lead is made of graphite, which is harmless. Pencils are not made of poisonous lead. Coloured lead pencils are also nontoxic. However, the graphite will cause a long-lasting skin mark if it is not scrubbed out.

Risk factors

• Puncture wounds increase your risk of infection because they are hard to clean and provide a warm, moist place for bacteria to grow.
• The bacteria Pseudomonas are a common cause of infections when a puncture wound occurs through the sole of an athletic shoe.

Causes of Puncture Wound

Metal: Nail, sewing needle, pin, tack

Pencil: Pencil lead is actually graphite (harmless). It is not poisonous lead. Even colored leads are not toxic.

Wood: Toothpick

Symptoms

Symptoms could include

• Open sores on the foot
• Pus
• Drainage
• Bleeding
• Pain
• Localized redness and swelling
• Inability to bear weight on the foot
• Red streaking of the skin
• An object visibly lodged in the foot.

Foot puncture wounds

Puncture wound complications

Possible complications from a cut or puncture wound include:

• A wound infection
• A blood infection, or sepsis
• Gangrene
• An amputation
• A loss of function in the area of the wound
• Nerve damage
• Organ damage

Diagnosis and test

The evaluation is based on a thorough history of what caused the puncture wound and the circumstances surrounding the event. The doctor will ask about the time from injury to evaluation, type of object that caused the injury, an estimate of the depth of penetration, inspection of the object if available, and whether or not footwear was worn if the injury is to the foot.

• Patients will be asked about the date of their last tetanus shot.
• X-rays may be taken as needed, to look for any possibility of an object left behind in the puncture wound or to assess any damage to the underlying bone.
• Ultrasound may also be performed.

Treatment and medications

Treatment depends on how severe the wound is and when the injury happened. You may need any of the following:

• Wound cleaning may be needed to remove dirt or debris. This will decrease the chance of infection. Before the wound is cleaned, your healthcare provider may give you medicine to numb the area and help you relax.
• Determine Whether the Wound Requires Stitches – Usually, wide puncture wounds may require stitches. If stitches are needed, then proceed to the emergency department.
• Apply Antiseptic Ointment – Use antiseptic ointment and cover with adhesive bandages, if the wounds are smaller and do not require stitches.
• Clean and Change Bandages – It is necessary to clean and change the wound dressings daily. While changing the dressing, it is essential to clean the wound and look for signs of infection.

• Pain Relief – Acetaminophen or ibuprofen can be used as required for getting relief from pain.
• Observe for Signs of Infection – Check for signs of infection, during the dressing changes or if the victim develops a fever, chills, or is feeling poorly. If there is increasing redness or swelling around the wound, or drainage from the wound, especially pus-like drainage or if the redness begins to radiate or streak away from the puncture wound, then it is essential to schedule consultation with a doctor as early as possible.
• A tetanus vaccine may be needed. Tell your healthcare provider if you have had the tetanus vaccine or a booster within the last 5 years. You may be given a tetanus shot, if needed.
• Surgery may be needed if your wound needs a lot of cleaning or removal of deep foreign objects. Your wound may be left open until it heals, or it may be closed with stitches.

Home Care Advice for Puncture Wound

Cleansing: Wash with soap and warm water for 15 minutes. For any dirt or debris, scrub the wound surface back and forth with a wash cloth to remove it. If the wound rebleeds a little, that may help remove germs.

Trimming: Cut off any flaps of loose skin that seal the wound and interfere with drainage or removing debris. Use a fine scissors, after cleaning them with rubbing alcohol.

Antibiotic Ointment: Apply an antibiotic ointment and a Band-Aid to reduce the risk of infection. Re-soak the area and re-apply an antibiotic ointment every 12 hours for 2 days.

Pain Medicine: Give acetaminophen or ibuprofen for any pain.

Expected Course: Puncture wounds seal over in 1 to 2 hours. Pain should resolve within 2 days.

Call Your Doctor If

• Dirt in the wound persists after 15 minutes of scrubbing
• Pain becomes severe
• It begins to look infected (redness, red streaks, tenderness, pus, fever)
• Your child becomes worse or develops any of the “Call Your Doctor Now” symptoms

Prevention of Puncture Wound

To prevent puncture wounds, be sure to practice safety when using blunt or sharp objects.

• Pay close attention to what you are doing.
• If you become distracted, set the object aside until you can pay attention to what you are doing.
• Know how to use the object properly.
• Have good lighting so you can see what you are doing.
• Wear gloves whenever possible to protect your hands.
• Wear other safety gear, such as glasses or boots, as appropriate.
• Hold a sharp object away from your body while using it.
• Carry the object with the dangerous end away from you.
• Shut the power off and use safety locks on your power tools when you are not using them.
• Be very careful when using high-pressure equipment, such as staple guns or paint sprayers. Make sure your work area is clear of people and hazards that could interfere with the safe operation of the equipment.
• Store dangerous objects in secure places away from children.
• Teach children about safety, and be a good role model.
• Do not use alcohol or drugs when you are handling sharp objects.
• Be sure to have a tetanus shot every 10 years.