Description, Causes and Risk Factors:
Puncture wounds are not the same as cuts. A puncture wound has a small entry hole caused by a pointed object, such as a nail that you have stepped on. In contrast, a cut is an open wound that produces a long tear in the skin. Puncture wounds require different treatment from cuts because these small holes in the skin can disguise serious injury.
Puncture wounds are common in the foot, especially in warm weather when people go barefoot. But even though they occur frequently, puncture wounds of the foot are often inadequately treated. If not properly treated, infection or other complications can develop.
Small, clean, superficial puncture wounds uniformly do well. The pathophysiology and management of a wound is dependent upon the material that punctured the foot, the location, depth, time to presentation, footwear and underlying health status of the victim. Punctures in the metatarsophalangeal joint area may be of higher risk of bone and joint involvement. Children brought by a parent, adults with on-the-job injury and patients seeking tetanus shots tend to present earlier and thus have a lower incidence of infection. Patients who present after 24 hours may have an early subclinical infection. Unsuspected fragments of sock or rubber sole are a major source of potential infection.
A variety of foreign bodies can become embedded in a puncture wound. Nails, glass, toothpicks, sewing needles, insulin needles, and seashells are some common ones. In addition, pieces of your own skin, sock, and shoe can be forced into the wound during a puncture, along with dirt and debris from the object. All puncture wounds are dirty wounds because they involve penetration of an object that is not sterile. Anything that remains in the wound increases your chance of developing other problems, either in the near future or later.
When the foot is punctured, the cornified epithelium acts as a spatula, cleaning off any loose material from the penetrating object as it slides by. This debris often collects just beneath this cornified layer which then acts like a trap door holding it in. Left in place, this debris may lead to lymphangitis, cellulitis or abscess. Saucerization or excision of wound edges allows for the removal of debris and the unroofing of superficial small foreign bodies or abscesses found beneath the thickly cornified skin surfaces.
Problems with function or feeling below the wound site.
Infection may occur with puncture wounds.The following types are more likely to become infected:
Wounds on the feet.
Wounds that are not promptly treated.
A diagnosis is made by visual examination and may be confirmed by a report of the causal events. Medical personnel will also assess the extent of the wound and what effect it has had on the patient's well being.
A puncture wound must be cleaned properly and monitored throughout the healing process to avoid complications. Treatment of wounds involves stopping any bleeding then cleaning and dressing the wound to prevent infection. Additional medical attention may be required if the effects of the wound have compromised the body's ability to function effectively.
Even if you have gone to an emergency room for immediate treatment of your puncture wound, see a foot and ankle surgeon for a thorough cleaning and careful follow-up. The sooner you do this, the better: within 24 hours after injury, if possible.
The surgeon will make sure the wound is properly cleaned and no foreign body remains. He or she may numb the area, thoroughly clean inside and outside the wound, and monitor your progress. In some cases, x-rays may be ordered to determine whether something remains in the wound or if bone damage has occurred. Antibiotics may be prescribed if necessary.
To prevent puncture wounds, be sure to practice safety when using blunt or sharp objects.
Have good lighting so you can see what you are doing.
Hold a sharp object away from your body while using it.
Carry the object with the dangerous end away from you.
Shut the power off and use safety locks on your power tools when you are not using them.
Be very careful when using high-pressure equipment, such as staple guns or paint sprayers. Make sure your work area is clear of people and hazards that could interfere with the safe operation of the equipment.
Store dangerous objects in secure places away from children.
Teach children about safety, and be a good role model.
Do not use alcohol or drugs when you are handling sharp objects.
Pay close attention to what you are doing.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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