Skin Wounds

Classification

Chapter 16 (pages 328-332)

Soft Tissue Injuries

o Trauma that happens to the skin is
visually exposed
o Categorized as a skin wound
o Defined as a break in the continuity of
the soft parts of body structures caused
by a trauma to these tissues
o Mechanical forces include:
o Friction, scraping, compression, tearing,
cutting, penetrating

Abrasion
o Skin scraped against
a rough surface
o Several layers of skin
are torn loose or
totally removed
o Usually more painful
than a deeper cut b/c
scraping of skin
exposes millions of
nerve endings

AbrasionTreatment
o Wash wound to remove all dirt and debris
o Soap and water or hydrogen peroxide
o Scrub wound if particles of dirt, rocks, or tar
embedded

o Leave open to air, unless oozing of fluid or

blood
o Apply antibiotic ointment to inhibit
infections
o Scrapes scab over quickly

AbrasionTreatment
o Loose skin flaps my form natural dressing; if
flap dirty remove with clean nail clippers
o Check on date of last tetanus immunization
o Watch for signs of infection
o Seek medical attention if any of following:
o Pain increases after several days
o Redness/red streaks appear beyond edges of
wound
o Swelling
o Purulent drainage

Laceration
Flesh irregularly torn; cut or tear in the
skin
Minimal bleeding, minimal pain, & no
numbness or tingling
Cuts 0.25 (6mm) deep and 0.5 (1.3cm) long
& have smooth, edges can be treated at home
Deeper lacerations should be treated by
physician (stitches)

Laceration

Laceration

LacerationTreatment
o Cleaned with soap and water
o Irrigate with clean water to remove
debris
o Do NOT use alcohol, iodine, or peroxide
as it may cause further damage and
slow healing process
o Stop bleeding
o Cover wound with sterile gauze
o Apply direct & constant pressure (15min+)

LacerationTreatment
o Once wound cleaned,
antibiotic ointment
may be applied to
reduce risk of
infection & aid healing
o Change sterile
dressing daily as
needed
o Bruising and swelling
are normal
o Apply ice to site
o Elevate area above
level of heart

o Contact a physician if:

o Laceration more than
0.25 (6mm) deep and
0.5 (1.3cm) long
o The wound is in area
where wound by be
opened by simple
movement of body part
o Wound on face, eyelids,
or lips
o Deep cuts on palm,
finger, elbow or knee
o Loss of sensation or
ROM of body part as
result of cut

LacerationTreatment
Stitches

Steri-Strips

Avulsion
o Layers of skin torn off completely or
only flap of skin remains
o Same mechanism as laceration, but
to extent that tissue is completely
ripped from its source
o May be considerable bleeding

AvulsionTreatment
o Clean wound with soap and water
o If flap of skin remains connected
replace skin in its original position
o If deep avulsion, seek medical attention
for stitches
o If large piece of skin torn off place in
plastic bag and put on ice
o Skin should not get frozen or soaked in water
o Take skin in plastic bag to doctor; may be
able to save and replace torn-off piece

Puncture Wound
o Penetration of skin by sharp object
o Nails, tacks, ice picks, knives, teeth,
needles

o May be small in diameter and not

seem serious
o Do require treatment by physician
o Can become infected easily b/c dirt
and germs carried deep in the tissue

Puncture Wound
Treatment

o Find out if part of object that caused

wound still in the wound
o i.e. lead from a pencil

o Determine if other tissues have been

injured by the object
o Blood vessels, nerves, tendons, ligaments,
bones, internal organs

o Prevent infections
o Bacterial skin infections, tetanus, infections
in deeper structures (bones and joints)

Puncture Wound
Treatment

o Risk of infections increases if:

o wound was exposed to soil (may
contain tetanus or other bacteria)
o went through sole of shoe ( risk of
bacterial infection that is difficult to
treat)
o injected into skin under high pressure
o i.e. nail from nail gun, paint from
high-pressure paint sprayer
o Physician should be consulted if object
penetrated deeply

Contusion
o A blow compresses or crushes
the skin surface and produces
bleeding under the skin
o Does not break skin
o Bruising due to injury to blood
vessels
o Most mild and respond well to RICE

ContusionSigns &
Symptoms
o Swelling
o Pain to touch
o Redness

o Ecchymosis
o accumulation of blood
in skin & subcutaneous
tissue more than one
cm in diameter
o General term=bruising
o Result of bleeding;
clotting or bleeding
disorders
o Bluish lesion at earliest
stages of onset

ContusionTreatment
o Careful monitoring
o Anti-inflammatory oral medications
o Compressive dressing
o Ice
o Modalities to ecchymosis, swelling,
ROM
o Myositis ossificans: calcification that forms
within muscle
o Requires surgical intervention

Blister
o Continuous rubbing over
the surface of the skin
causes a collection of
fluid below or within the
epidermal layer

BlisterTreatment
o Wash area
thoroughly
o Use sterile blade to
cut small hole in
blister
o Squeeze out clear
fluid
o Do not remove skin

o Prevention:
o Wear work gloves
o Break in new shoes
o Petroleum jelly/skin
lube
o Adhesive bandage

Incision
o Skin has been sharply cut
o Surgical cut made in skin or flesh

IncisionTreatment
o Remove bandage day after surgery;
replace daily or as needed
o Normal for edges of healing incision
to be slightly red
o Call physician if:
o redness increases/spreads more than half an
inch
o pus in incision
o more than mildly tender or painful

Incision
Treatment
o Keep incision clean & dry for several
days after surgery
o Non-absorbable sutures or staples must
be kept dry until doctor removes
o Steri-strips should be kept dry 4-5
days
o On face, hands, arms: take showers or
tub baths along as affected area stays
dry

Wound Care
o Irrigate with clean, cool water to wash
away foreign particles
o Gentle wash with mild soap (superficial
cuts only)
o Minor cuts/abrasions should be washed,
dried with sterile gauze sponge, and
treated with first aid cream
o Apply dry, sterile bandage, large
enough to cover entire injury

Wound Care
o Clean bandage should be applied daily
o Athlete should be instructed on how to
clean & manage wound
o Athlete should check for signs of infection:
o Redness
o Swelling
o Increased pain
o Oozing of pus
o Increase body temperature

Care of Open Wounds

Chart in Arnheimp 928

Skin Infections
o Skin always has some amount of
bacteria, fungus, and viruses living on
it
o Skin infections occur when there are
breaks in the skin and the organisms
have uncontrolled growth
o It is more important to understand the
potential for infection rather than
placing a name on the skin problem

Skin Infections
o Bacteriacan be cured
o Staphlococcus
o Including MRSA & Impetigo

o Streptococcus

o Fungalcan be cured
o Ringworm

o Viralcannot be cured, but can be treated

o Herpes
o Warts
o Molluscum contagiosum

When to Worry
o Lesions with an
irregular border
o Raised skin lesions
o wet or moist lesions
o Lesions that have
different colors within
the lesion
o Bright red colored
lesions are more of a
problem compared to
faded lesions

o Lesions that are warmer

compared to other skin
o Inflammation &
irritation around skin
lesion
o Prior history of
infectious skin lesion
o Skin abrasions
o Deeper or more
traumatic break in skin,
higher risk for
subsequent infection

Skin Infections
o The right antibiotic is required to
cure a specific bacterial skin infection
o Antibiotics for bacteria will not
improve fungal or viral infections
o Bacterial infections can be the
fastest growing infections
o Thus the most easily spread among
athletes

Staph
o Infection caused by
Staphylococcus
bacteria
o About 25% of people
normally carry staph
in the nose, mouth,
genitals, and anal
areas
o Infection begins with
a little cut gets
infected with
bacteria

o Range from a simple

boil to antibioticresistant infections
to flesh-eating
infections
o Difference is:
o the strength of the
infection
o How deep it goes
o How fast it spreads
o How treatable it is
with antibiotics

MRSA
o Methicillin resistant Staphylococcus
aureus
o Resistant to certain antibiotics most
are skin infections
o Methicillin, oxacillin, penicillin, amoxicillin

o More severe or potentially lifethreatening occur most frequently

among patients in healthcare settings

Symptoms of MRSA
Skin Infections
o Appear as pustules or
boils
o Red
o Swollen
o Painful
o Pus or other drainage
o First look like spider
bites or bumps
o Occur at sites of
visible skin trauma

Severe Infections
o Potentially lifethreatening
o Blood stream infections
o Surgical site infections
o Pneumonia

o Signs & symptoms vary

by type and stage of
infections

Causes of MRSA
o Spread by having
contact with
someones skin
infection or
personal items
theyve used
o Spread in places
where people are
in close contact

o Close skin-to-skin
contact
o Openings in the skin
(cuts or abrasions)
o Contaminated items
& surfaces
o Crowded living
conditions
o Poor hygiene

Personal Prevention of
MRSA

o Good hygiene
o Keep hands cleanwash with soap and
water thoroughly
o Keep cuts and scrapes clean & covered
with a bandage
o Avoid contact with others
wounds/bandages
o Avoid sharing personal items i.e.
towels, razors

Prevention of MRSA in
Athletics
o Practice good personal
hygiene
o Keep hands clean
o Shower after exercise
o Do not share soap or
towels
o Wash uniform & clothing

o Take care of your skin

o Cover abrasions/cuts
o Change bandages
regularly

o Do not share items

that come in contact
with your skin
o Towels & razors
o Ointments

o Take precautions with

common surfaces &
equipment
o Use barrier between
skin & surface (towel,
clothing)

Diagnosis & Testing of

MRSA

o Culture must be obtained

o Small biopsy of skin

o Drainage from infected site
o Blood
o Urine

o Sent to microbiology laboratroy

o Tested for S. aureus infection
o Determine which antibiotics will be
effective

Treatment of MRSA
o Antibiotic to drain infection
o DO NOT attempt to treat yourself!
o Includes popping, draining, using
disinfectants on area

o If you think you have an infection:

o Cover affected skin
o Wash hands
o Contact physician

MRSA Statistics
o 2005: estimated 94,360 people develop serious
MRSA infection
o Approx 18,650 person died during hospital stay
related to these serious MRSA infections
o About 85% of all invasive MRSA infections were
associated with healthcare (2/3 outside of
hospital)
o About 14% of all infections occurred in persons
without obvious exposures to healthcare

MRSA

MRSA

MRSA

MRSA

Impetigo
o Mild itching & soreness
o Eruption of small vesicles and/or pustules
that rupture to form honey-colored crusts
o Combo of 2 bacteria that spread rapidly
when athletes in close contact with one
another
o Responds rapidly to proper treatment
o Thorough cleansing of crusted area
o Application of topical antibacterial agent

ImpetigoCauses
o Caused by streptococcus (strep) or
staphylococcus (staph) bacteria
o MRSA becoming common cause
o May occur on skin where there is no
visible break
o Most common in children, particularly
unhealthy living conditions
o Infection carried in fluid that oozes
from blisters

ImpetigoSymptoms
o Single or many blisters filled with pus
o Easy to pop
o When broken leave a reddish raw-looking
base

o Itching blister
o Filled with yellow or honey-colored fluid
o Oozing and crusting over

o Rash
o Skin lesions on face, lips, arms, or legs
o Swollen lymph nodes near infection

Impetigo

Folliculitis
o Inflammation of a hair follicle
o Starts when hair particles damaged by
friction
o Clothing, blockage of follicle, shaving

o Frequently become infected

o Bacteria Staphylococcus (staph)

o Painless or tender pustule (pimple)

o May crust over

o Rash or itching

Folliculitis

Ringworm
o Skin infection
caused by fungus
(not a worm )
o Fungi thrive in
warm, moist areas
o Often several
patches at once
o Contagious

o Symptoms:
o Itchy, red, raised scaly
patches that may
blister and ooze
o Patches often have
sharply-defined edges
o Redder around
outside; normal skin
tone in center
o Skin appear unusually
dark or light

Ringworm Types
o Bodytinea corporis
o Scalptinea capitis
o Grointinea cruris (jock itch)
o Feettinea pedis (athletes foot)

Ringworm

Herpes Gladitorium
(Viral)

o Caused by herpes
simplex virus Type 1
o Spread by direct
skin-to-skin contact
o Lesions/sores appear
within 8 days after
exposure
o Appear as cluster of
blisters
o Diagnosis upon
appearance

Cauliflower Ear
o Deformity of outer ear
o Caused by accumulation of blood
beneath the external surface of ear &
underlying cartilage
o Blunt trauma to ear to cause
hematoma or bruising of tissue to
develop into this deformity
o Seen in wrestlers, rugby players, boxers

Cauliflower Ear
o Painful & physically deforming
o Fluid accumulates beneath skin surface
of ear
o Underlying cartilage is deprived of blood
supply & nutrients necessary for normal
functioning
o If fluid not removed hardening of
tissues & keloid formation results
o Gives ear shriveled & deformed appearance

Cauliflower Ear
Treatment

o ICE
o See physicianoften necessary for fluid to
be aspirated
o Drained with needle

o Placement of custom-made, form fitting

compression dressing made of hardened
casting material
o Worn 3-5 days continuously
o Athlete return to activity wearing both device
and appropriate headgear

Cauliflower Ear

Cleaning & Disinfecting

o Cleaners
o Products used to
remove soil, dirt,
dust, organic matter,
& germs (bacteria,
viruses, fungi)
o Work by washing
surface to lift dirt &
germs off surfaces
so thy can be rinsed
away with water

o Sanitizers
o Used to reduce germs
from surfaces but not
totally get rid of them
o reduce germs to level
considered safe

o Disinfectants
o Chemical products that
destroy or inactivate
germs & prevent them
from growing
o No effect on dirt, soil,
or dust

Which one to use?

o Disinfectants effective against staph most
likely also effective vs. MRSA
o Products readily available from
grocery/retail stores
o Check product label
o List of germs that product destroys

o Use disinfectants that are registered by the

EPA
o Check for EPA registration number on product
label for confirmation

How should cleaners &

disinfectans be used?
o Read the label first. Each cleaner and
disinfectant has instructions on the
label that tell you important facts:
o How to apply the product to a surface
o How long you need to leave it on the
surface to be effective
o If the surface needs to be cleaned first and
rinsed after using
o If the disinfectant is safe for the surface
o Whether the product requires dilution with
water before using
o Precautions you should take when applying
the product (wearing gloves or apron)

Disinfection Guidelines
o All floor and wall padding in athletic areas
should be washed daily (if athletic area is
used)
o Separate mop head/buckets should be
used for each activity area, locker room,
and restroom.
o Mop heads & buckets should be cleaned
regularly

o Towels/linens laundered on premises

should be washed with detergent at a
minimum of 160F & dried in hot dryer

Disinfection Guidelines
o CAUTION! If clean athletic gear is dumped
into a dirty laundry bag or gym bag, the
gear immediately becomes a source of
infection
o Liquid (not bar) soap should be readily
available and provided by wall dispenser
close to sinks & next to showers
o Sports equipment should be cleaned
regularly
o Balls, racket grips, bats, gloves

Disinfection Guidelines
Wrestling Room & Mats
o Mat surfaces with small holes or tears
should be repaired with mat tape.
o Mat surfaces should be replaced
promptly when there are large holes
or surfaces are excessively worn
o Both sides of the mats should be
cleaned thoroughly before and after
each use for practices and meets

Maximize Athletic Success!

Minimize Risk of Infection!