Have you seen my finger? A guide to wound care.

lacerationLast week, as my wife is finishing dinner, I’m cleaning a couple of glasses for iced tea. I’m not sure what happened, but the glass starts to fall. Unfortunate to be blessed with ninja-like reflexes, I catch it. Sort of. In catching it, I slam it into the granite, and it breaks in my hand. The bottom half falls to the ground while the part I’m still holding cuts into my left pinky finger. Disregarding the germ theory, I grab some paper towels to hold pressure. I’m trying to keep the kids and the dog from walking through the glass as I clean it up and drip blood on the floor. I didn’t really have time for this. I was getting together in 30 minutes for a neighborhood card game. Still had to get the kids in the chairs for dinner. Still had to eat. Long story short, I had some wound glue and fixed it. It bled under the glue and didn’t look very professional, but a Band-Aid took care of that. However, my near-ampuation (not quite) made me think: if I weren’t a doctor, would I have gone to the hospital? Would I have known how to treat it or what infection would look like?

Mostly, wounds need good cleaning. With water. Not with peroxide, not with alcohol, or whatever other home remedy you’ve heard. In the hospital, we use saline (salt water at the normal “salt” level of your body, so it doesn’t burn). But, tap water works just as well. It’s the “irrigation” effect of the water, squirting the bacteria out, so soaking in water won’t do the trick. Once it’s clean and there are no foreign bodies (like glass) in there, you have to make certain nothing bad is injured. If everything is working ok, and nothing is particularly numb, especially if the cut is superficial (not deep), then it’s likely it’s just a simple laceration.

The next step is deciding if it needs sutures (stitches). Stitches help cuts heal faster. They can make the scar smaller. In general, the more cosmetic an area (like the face), the more likely a cut needs some repair. Hand lacerations less than an inch or so tend to do ok without stitches. If bleeding is an ongoing issue, sutures can sometimes help that by bringing those edges together and allowing all the little clotting factors to do their thing. Sutures probably don’t prevent infection, other than the fact that it restores our best bacteria-fighting organ, our skin, back to some integrity. In fact, some really nasty, contaminated wounds we don’t suture initially, we bring you back a couple of days later for something known as delayed primary closure, once we’re certain the laceration is not looking infected.

Most cuts don’t need oral antibiotics, just good wound care, which can include topical antibiotics. I’ll let you discuss that on an individual basis with your doctor. While all cuts scar, there are some things you can do to decrease that. One is prevent infection, or treat it early if it develops. Signs of infection include redness (getting worse), swelling, pus, fever, increasing pain. Once the laceration is healed, rubbing vitamin E oil into the wound helps soften the scar. Another way to minimize scarring is to keep the wound out of the sun for the first year. Scars like to soak up pigment in our skin, which is essentially what a tattoo is: scar the skin with pigment. So, either cover, or really strong sun screen.

  • Clean the cut – usually running tap water is fine
  • Maker certain everything works ok – not tendon or nerve damage
  • Decide if this cosmetically needs to be fixed
  • Apply antibiotic ointment twice a day
  • See a doctor if the cut gets infected
  • Try vitamin E oil and sunscreen to minimize the scar

If I hadn’t been in such a hurry when I got cut, I probably would have just wrapped it with some gauze after I applied some antibiotic ointment. Being a doctor, I got to cheat with the glue.

What wounds have you had that you wish you had treated differently?