Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Miscellaneous Injuries

Open wounds

Open wounds are common among athletes, particularly those who play contact sports such as soccer, American football, rugby, and ice hockey. Riders, orienteers, and cyclists, who are likely to sustain falls on to hard surfaces, are also vulnerable. The way in which a wound is inflicted determines its nature and extent, and the possibilities include cuts, contusions, lacerations, gashes, puncture wounds, and abrasions. Some wounds may only affect the outer layers of skin; others may damage tendons, muscles, blood vessels, and nerves. 

 
The healing of a wound is delayed by the presence of dirt and infection, bleeding, gaps between the wound edges, and disturbance of the injured tissue. Treatment aims to eliminate these factors.

Treatment

In order to stop bleeding, the athlete or trainer should:

– elevate the injured part. In most cases of limb injury, supporting the limb in a raised position with the injured athlete lying supine or on one side is sufficient to stop the bleeding;
– apply direct pressure. With one hand on each side of the wound, press the wound edges together while the injured limb is kept elevated, with the help of a third person if necessary. The risk of contamination of the wound is reduced if the wound surfaces themselves are not touched. If alone, the athlete should stop the bleeding by pressing directly on the wound;  
– apply a pressure bandage as soon as first aid supplies have been obtained. The wound edges should be brought into apposition as described above, and a folded pad or clean handkerchief may be bandaged in place to increase the pressure on the area. A tourniquet should never be used, and even a pressure bandage must not be kept in position for more than 10–20 minutes. If a pressure bandage has been necessary to stop the bleeding, a doctor should be consulted.

Cleaning

Superficial wounds that have been contaminated by dirt must be cleaned carefully within 6 hours, otherwise they will become infected as bacteria begin to multiply and penetrate tissues. It is essential that all dirt is removed, especially from abrasions on the face, as retained material can cause disfiguring scars. Heavily contaminated abrasions should be cleaned thoroughly for several minutes with soap and water and a soft nail-brush. They should then be rinsed with large amounts of plain water or a saline solution, and covered with a sterile compress, held in place by a bandage. If fluid seeps through the dressing it should be changed daily. A doctor may prescribe medicated dressings to facilitate healing. Small superficial abrasions heal best if cleaned well and left undisturbed. 

Deep wounds include skin, underlying connective tissue, and possibly also tendons, muscles, blood vessels, and nerves. The wound edges often gape apart and bleeding can be considerable. Puncture wounds caused by studs or spiked shoes can be treacherous and should always be treated by a doctor. Wounds to the sole of the foot require padding to distribute load when walking. Deep wounds must be cleaned with extreme care, and, when damage is extensive, it is sometimes necessary for the doctor to excise dead tissue (debridement). A sound rule is that wounds that are not treated within 6 hours should be considered to be infected.

Some wounds—those that are deep, those that bleed profusely, and those whose edges do not lie readily in apposition with each other— need to be stitched by a doctor. Stitching should preferably be done within 6 hours of the injury.

Infected wounds are characterized by pain, swelling, redness of the skin and local tenderness. Infection can spread from the wound to the lymph glands via the lymphatic vessels. Infection in the leg, for example, spreads to the glands in the groin. When this happens, the lymphatics appear as red streaks in the skin, and other symptoms, such as fever and general malaise, commonly occur. The affected lymph glands are swollen and tender. The condition should always be treated by a doctor who will prescribe antibiotics in addition to any other treatment. A period of bed rest may be necessary during the acute illness.

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