Lacerations & Abrasions

The Skin

The skin is the largest organ of the body, and it is the first line of defense against disease and any breach in skin integrity has the potential to develop an infection1. The skin has several important functions, it protects the body from invading bacteria and other harmful allergens in the environment and it helps regulate the body’s internal temperature2. The skin also contains an extensive network of nerve cells and receptors that detect and relay changes in the environment. As a sensory organ the skin allows us to experience a wide range of sensations. The skin contains separate receptors for light touch, pain, itch, warmth, and cold3.

The skin is composed of three layers; the epidermis, dermis and hypodermis.

Epidermis

The epidermis is the outer layer of the skin which acts as a physical barrier to the external environment. It helps prevent penetration by irritants and allergens. At the same time, it prevents the loss of water and helps maintain the body’s internal balance.

Dermis

The dermis forms the inner layer of the skin and is much thicker than the epidermis. The primary role of the dermis is to sustain and support the epidermis. The main functions of the dermis are: protection; cushioning the deeper structures from mechanical injury, providing nourishment to the epidermis and assists wound healing.

Hypodermis

The hypodermis is the subcutaneous layer lying below the dermis; it consists largely of fat. It provides the main structural support for the skin, as well as insulating the body from cold and aiding shock absorption. It is interlaced with blood vessels and nerves4.

How you care for your skin can make a difference between health and illness, and any breach in skin integrity has the potential to introduce an infection5. Lacerations and abrasions are classified as acute wounds and require care to ensure they heal without incident.

What is a Laceration?

A laceration is a cut to the skin. Small non-penetrating cuts on the fingers or hands are common and should heal without any problems. Some cuts may be deeper, penetrating the skin to the underlying layers of fat or muscle. However, if the cut is deep, extending through the skin into the deeper layers, then blood vessels, nerves or tendons may be damaged. Damage to nerve cells can result in a loss of sensation in the affected area this is referred to as neuropathy6.

What is an Abrasion?

Abrasions are scrapes that result in damage only to the epidermis and occur when the epidermis comes into contact with a rough surface such as concrete or a road8. Abrasions are usually painful and cause minimal bleeding. While typically classified as minor in nature, abrasion injuries can be serious if a large surface area is damaged or foreign materials such as dirt or gravel become embedded in the wound. Deep abrasions that extend below the dermis should be assessed by a doctor to determine the appropriate treatment.

Management of lacerations 

  1. Always wash your hands with soap and water for 15 to 30 seconds before cleaning a wound. If your hands are not visibly dirty, you can use an alcohol-based hand sanitiser. This helps avoid infection.
  2. Stop the bleeding. Minor cuts and scrapes usually stop bleeding on their own. If needed, apply gentle but firm pressure with a clean bandage or gauze. If possible elevate the wound until bleeding stops.
  3. If after 5 minutes the bleeding does not stop, pad the wound generously with gauze and wrap firmly with a bandage. You should seek the advice of a doctor as soon as possible.
  4. Clean the wound with warm (clean drinking water). Tap water is a safe alternative to sterile normal saline for wound cleansing 9 10.
  5. Keep the wound under running warm tap water this will help reduce the risk of infection and help remove any visible dirt or other debris such as wood splinters or glass. Pat dry and apply a thin layer of antiseptic cream to maintain a moist environment. Note: If you are unable to remove all debris, a doctor should assess the wound.
  6. Cover the wound with a clean bandage or piece of gauze. For best results, an occlusive non-adherent wound dressing that maintains a moist environment is preferable as wounds heal faster in a moist environment. A dressing that maintains a moist environment also reduces the potential for infection. This type of dressing can result in less scarring and provide comfort com­pared to a dry gauze dressing 11 12. Seek advice from your pharmacist for the most appropriate dressing and how often it should be changed.
  7. Change the dressing if the dressing becomes wet or dirty.
  8. Observe for signs of infection which may include: redness, increasing pain, warmth or swelling or an increase in fluid coming from the wound. This may indicate the wound is infected. You should see a doctor as soon as possible 13.

Management of abrasions

Follow the same steps for managing lacerations except for step 6. If the abrasion is small and superficial and cleansed then the wound can be left open to heal without a dressing in place.

  1. On small abrasions a scab may form and should not be removed as it provides protection from more injury and infection. Once a scab has formed, it usually remains dry and does not ooze fluid. The scab will fall off as the skin below heals.
  2. A scab that forms over a joint, such as a knee or elbow, may crack and a few drops of clear yellowish to pinkish fluid may ooze from the wound. Cleanse the scab with warm (clean drinking water) and pat dry 14.
  3. Continue to observe for signs of infection: redness, increasing pain, warmth or swelling or an increase in fluid coming from the wound. This may indicate the wound is infected, you should see a doctor as soon as possible 15.
  4. Large and deep abrasions should always be assessed by a doctor to ensure there is no debris or damage to underlying structures.

You must seek medical advice when: 

  • Your wound is deep
  • The edges of the wound are gaping open (you may need stitches)
  • Note: if the wound bleeds in spurts and blood soaks through the bandage (you may have a damaged artery). You should attend the emergency department in your local hospital
  • If bleeding does not stop after 5 minutes of firm, direct pressure
  • You have a puncture wound or a deep cut caused by a dirty or rusty object (you may need a tetanus booster)
  • The area around the wound feels numb (you may have some nerve damage)
  • You have a temperature at or over 38.3°C (may be a sign of infection)
  • Signs of infection: increasing redness, increasing pain or increasing drainage of yellow coloured pus
  • If you have diabetes, vascular disease or heart disease as these conditions can negatively impact on wound healing
  • You are taking medications such as steroids or blood thinners as these too can impact on healing
  • A wound located on the face (may need further investigation for cosmetic purposes).

References

  1. Lawton S (2019) Skin 1: the structure and functions of the skin. Nursing Times[online] 115, 12, 30-33.
  2. Osilla, E.V., Marsidi, J.L., Sharma, S. Physiology, Temperature Regulation. [Updated 2020 Apr 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507838/
  3. Owens, D. M. & Lumpkin, E. A. (2014). Diversification and specialization of touch receptors in skin. Cold Spring Harbor perspectives in medicine. 4(6), a013656. https://doi.org/10.1101/cshperspect.a013656
  4. Julian, M. K. Skin failure in patients with a terminal illness, Nursing Made Incredibly Easy! July/August 2020 (18) 4, 28-35 doi: 10.1097/01.NME.0000658176.61999.fb
  5. Romanovsky A. A. (2014). Skin temperature: its role in thermoregulation. Acta physiologica (Oxford, England). 210(3). 498–507. https://doi.org/10.1111/apha.12231
  6. Brannon, H. (2019). Subcutaneous tissue: the innermost layer of the skin. Very Well Health. Retrieved from https://www.VeryWellhealth.com/subcutaneous-tissue-1068882
  7. Twomeya, D. M., Petrassa, L. A., Fleming, P., Lenehana, K. Abrasion injuries on artificial turf: A systematic review Journal of Science and Medicine in Sport 22 (2019) 550–556
  8. “Abrasion.” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/abrasion. Accessed 13 Jun. 2020.
  9. Chan, M. C., Cheung, K., & Leung, P. (2016). Tap Water Versus Sterile Normal Saline in Wound Swabbing: A Double-Blind Randomized Controlled Trial. Journal of Wound Ostomy & Continence Nursing, 43(2), 140-147. doi:10.1097/won.0000000000000213
  10. Resende, M.M., Rocha, C.A., Corrêa, N.F., Veiga, R.R., Passos, S.J., Novo, N.F., Juliano, Y. and Damasceno, C.A. (2016), Tap water versus sterile saline solution in the colonisation of skin wounds. International Wound Journal, 13: 526-530. doi:10.1111/iwj.12470
  11. Fernandez, R. & Griffiths, R. Water for wound cleansing. Cochrane Database of Systematic Reviews, 2012 (2).
  12. Korting, H.C., Schöllmann, C., White, R. J. (2011).Management of minor acute cuta­neous wounds: importance of wound healing in a moist environment. Journalof the European Academy of Dermatology and Venereology. 25(2): 130-137.

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