Cuts and Scrapes

Your skin is your body's largest organ and plays a big role in keeping you healthy. It helps to regulate your body temperature and acts as a barrier to keep body fluids in and bacteria out. The skin also acts as a first-alert system to the world around you by warning of potential problems when you feel heat or pain.

Cuts and scrapes happen when your skin is accidentally broken or worn away. This can be the result of a fall, banging against a hard object, or being cut by something sharp

We all get cuts sometimes, but some people are more prone to these injuries than others. Children, for instance, almost always have some sort of minor skin damage just from playing. Others more likely to get cuts and scrapes include older people and people who have delicate skin because of certain illnesses or medications.

How can you tell if your cut or scrape is healing properly? If you keep the area clean, the chance of infection is low. Some signs of infection to watch for include:

• discharge or pus (yellow-grey fluid) coming from the cut or scrape
• fever
• increased pain
• foul odour coming from the cut
• redness, swelling, or warmth in the affected area

If any of these signs appear, your injury needs a doctor's attention. To stop the infection from spreading, treatment most often consists of an antibiotic cream or ointment (such as mupirocin*, bacitracin, or fusidic acid) or, in more severe cases, a prescription for oral antibiotics.

Certain people need to take special care if they get cuts or scrapes because their injuries won't heal easily. These include people who:

• have weakened immune systems (e.g., from chemotherapy medications used to treat cancer)
• take medications that make the skin dry and fragile (e.g., prednisone)
• take medications that decrease blood clotting (e.g., warfarin)
• have diabetes
• are elderly, as the skin gets thinner with age and healing happens more slowly

If you are in any high-risk category, find out what special precautions you should take to avoid injury and what to do if you injure yourself.

The most important thing to remember when dealing with a cut or open wound is to keep it clean. To prevent infection, make sure that anything that touches the scrape or cut is as clean as possible. This is not always easy, as bacteria are on almost everything in our environment. However, most medical supplies are sterilized and free of bacteria that may cause infection.

The first step in treating a cut is to control or stop the bleeding by applying a clean dressing or gauze to the cut with firm and even pressure that is not too hard – you don't want to cut off the circulation. Resist the temptation to lift the gauze and check to see if the blood has stopped, as you might disturb the clotting process. If there's a lot of blood and it's coming through the padding you're using, don't remove the padding. Instead, cover it with another cloth or pad and continue to apply pressure–this allows clotting to continue undisturbed. If the bleeding doesn't stop within 10 minutes, keep applying pressure and get the cut checked by a doctor.

The sooner you can cover the wound and slow down the blood flow, the easier the injury will be to deal with. Remember, many minor cuts – especially to the head and face – bleed a lot more than you might expect, since the blood vessels are denser in these areas of the body than in most others. If you've been able to control the blood flow, check the cut to see if it needs medical attention.

Cuts that require medical attention include the following signs:

• They are deep (doctors usually are more concerned with how deep a cut is rather than how long it is, because of the concern that deeper tissues like blood vessels, nerves, or tendons may be damaged)
• They expose any muscle tissue (red) or fat tissue (yellowish)
• They stay open if you let go of the sides of the cut
• They are on a joint or in an area where healing might be difficult (stitching might be needed to keep it closed)
• They have dirt or particles that are difficult to remove
• They continue to bleed after pressure is applied

If no medical attention is needed, treat the cut in the following way:

1. Cleanse the cut with tap water. You can also use a mild soap. This process helps remove any debris and bacteria from the cut. Avoid using cotton or wool to clean the cut because fibres may get into the wound and cause infection.
2. You can use astringents, alcohol, and antiseptics (e.g., hydrogen peroxide) on the area surrounding the cut, but it is best to avoid using them directly on or in the cut, as they can disrupt the natural healing process.
3. Dress the wound with an over-the-counter topical antibiotic to help prevent infection, if necessary.
4. Cover the wound with a dressing (cloth bandage) that can help keep the cut moist. If you are not sure what type of dressing to use, ask your pharmacist for a recommendation. Change the dressing daily, and more often if it appears dirty.

Stitches or glue?

Medicine has made many advances over the past few years, and there are several alternatives to stitches. A special tape or even glue can be used to close some wounds.

Stitches: The advantage to stitches is that the doctor can line up the edges of the cut squarely and cleanly, and the stitches keep the edges in place while the cut heals. This is particularly important if the cut is on a part of the body that moves a lot, such as a joint. If the wound is jagged or uneven, stitches are usually preferred.

Some stitches dissolve on their own, while others need to be removed. The disadvantage of stitches can be the stress, especially to children, of having the area frozen and the stitches put in. Removing stitches is painless, however. The most you might notice is a "tugging" feeling as the thread is pulled through the skin.

Some people are concerned that stitches will increase scarring. The reverse is the case if the wound is large. Stitches allow for better definition of the wound edges and decrease the biggest cause of scarring, which is gaping of the wound.

Steri-strips: Sometimes, a cut is deep enough to need some help, but not deep enough for stitches. Also, if a cut is on the face, doctors may try to avoid using stitches to minimize scarring. In this case, steri-strips or butterfly strips may be used. These strips are very fine, thin, and sticky, and they act like stitches. They usually stay on for a few days and then fall off on their own. The disadvantage is that they may not stay on long enough for certain cuts. Encourage children to not pick them off.

Skin superglue: Skin glue is being used more and more when stitches can be avoided, especially on cuts where you want to minimize scarring. The advantage is that the glue goes on quickly and painlessly. The disadvantage is that it can't be used on areas that bend a lot, such as the knuckle or other areas of high tension like the forehead.

How are scrapes treated?

Scrapes, unlike cuts, are not deep wounds, but they're still painful because they can cover a large, sensitive area of skin. The most important part about treating a scrape is cleansing.

Scrapes should be cleaned regularly while they're healing to keep the scab from getting too hard. A thick, hard scab can result in a more obvious scar. You may want to use an antibiotic ointment, usually available without a prescription, while the scrape is healing. If you want to cover the scrape, some bandages contain antibiotic padding, too. In addition, some commercial gauzes are available that have a coating to keep them from sticking to the wound. This makes removing the dressing a lot easier and leaves the scab intact. It is important to keep the wound from drying out while it is healing – a moist wound will heal faster and have less scarring. It will also help prevent the dressing from sticking to the wound.

Scrapes or lacerations are injuries to the skin that remove the barrier that protects us from potential infections with bacteria, including Clostridium tetani, also known as tetanus, a harmful bacteria found in soil.

People with skin injuries should ensure that their tetanus vaccinations are up to date. Generally, tetanus booster shots are required every 10 years to be considered up to date.