CUT UP


WOUND MANAGEMENT

Licking your wounds is something we’ve all learned to do since we’ve been old enough to fall over.

coral cut

It seems the fun police are winning in the UK, with ‘Health and Safety’ being used as their motto. Having said that, getting on a late night bus that’s twice your age, being driven (fast!) by a rasta smoking a spliff who’s using a monkey wrench instead of a steering wheel helps you reflect that perhaps the fun police aren’t all bad.. Maybe.

Skin wounds are probably one of the most common injuries sustained on surfing trips.

They’re not all bad. I remember my mate happily picking at his ‘Padang Cut’ on his leg when we were in Indo so it would scar. 12 years later its probably the only memento he has from that trip. Better than any holiday tattoo.

These are basic principles on how to manage a wound. Don’t use stuff you’re not happy using (like sutres). The better you care for any wound the less likey it is to become a problem.

The most important thing you can do though is recognize when it is becoming a problem and act on it. That may be antibiotics, or a trip to a hospital.

People die from infected cuts.

TYPES OF WOUNDS

HEAD INJURIES

 

If you think they’re acting funny or were knocked out get them to hospital. Make sure you’ve read the article on head injuries.

http://www.waterhound.com/surfing/lifestyle/4285-keala-kennellys-graphic-injury-at-teahupoo.html

 

DEEP WOUNDS

Any cut that goes all the way through the skin has the potential to damage things beneath the skin. You need to decide if arteries, nerves, veins or tendons are damaged too.

If you’re not sure you need to go to hospital.

Nerves: is there normal sensation on the skin to light touch away from the cut?

Tendons: is there full range of movement of the damaged part of the body?

Arteries: Feel for pulses if you know them. Press the skin hard for 5 seconds with your thumb away from the wound. The colour should return to the area you pressed before you can finish saying ‘sting in the shower’.

BITES             Twice shy.

Animal (including human) & fish mouths are dirty! Bites often result in nasty infections and need to be cared for and monitored carefully. It’s a good idea to start taking antibiotics if you’ve been bitten to prevent infection. Don’t forget than animals can leave teeth in the wound too. The best management of a dog bite would include a x-ray to check for teeth.

Don’t close the wound unless you are sure there is nothing left in it.

Don’t forget that bites can also cause significant crush injuries beneath the skin.

FOREIGN BODIES

Not the sexy kind! Foreign bodies need to be removed before you can close a wound. This is covered quite well in the article on Urchin Injuries.

FIN RUB / BLISTERS

fin rub

Fib Rub

The plague of every bodyboarder.

Prevention is the best cure. If I knew how to do that I would be rich.

Once you start to get a rub the best thing you can do is keep it clean and stop flies feeding on it.

No one is going to stop getting in the surf because of a few rubs. The best thing I’ve found for this the second skin sprays that are now availiable. They stop flies and dirt getting in them, and they offer a bit of protection from rubbing.

This is product I find really useful for keeping on top of fin rubs. There are loads of other similar sprays out there so shop around. The Savlon iodine spray mention in the ‘Medical Kit List’ article in the BEFORE YOU GO section is also a must bring in our opinion.

fin rub

CORAL CUTS

This common injury deserves a dedicated article, but the principles are the same. Read our article on coral cuts.

reef cut anyone?

CLEANING THE WOUND

This is often the bit that is done worst, but is probably the most important.

There is no rush, so take your time to carefully clean the wound.

  • Remove ALL the foreign bodies in the wound including any small chunks of flesh that you don’t think have a blood supply. Don’t get carried away removing flesh, if you think there’s more than a few small pieces it should be done by a surgeon! Having a pair of tweezers or a few new green needles are useful for this.
  • Wash the area really well. Drinking water is really useful. Sea water isn’t useful (contains small organisms & eggs) but is just about better than nothing.
  • Clean area with soap and use a disinfectant such as betadine. Cleaning products are discussed in a different article.
  • Using a clean syringe to blast the area with clean water can be useful to help dislodge debris and assess the depth of the wound and any underlying damage.
  • If you think there is damage to any nerves, arteries or tendons or the wound contains things that aren’t foreign bodies that you don’t recognize (like bone splinters) DON’T CLOSE THE WOUND. You need to get to a hospital to have the wound dealt with properly.

Dress the wound with sterile cloth and bandage. Change if necessary.

 

 

CLOSING WOUNDS

Bottom line is that if you don’t feel happy closing a wound then you shouldn’t.

If this is the case then regular cleaning, clean dressings and prophylactic antibiotics will reduce the chances of serious infection. A large wound should be dealt with in a hospital. Leaving a wound ‘open’ increases the risk of infection and worsens the scar.

Don’t close wounds that look infected, have resulted from bites or wounds that are over 12hrs old.

surfboard fin injury

Nasty cut from a surfboard fin.

METHODS OF CLOSING WOUNDS

Glue

Special superglue basically. Its great for small superficial cuts. The great thing about it is that it can be washed as normal after a couple of days.

Its easy to get your fingers stuck to the cut. Avoid contact with eyes.

Steristrips

These are basically small bits of tape. They last about 30 seconds in the sea.

If you think you can keep the wound dry they are great.

Tape

If you’re going in the sea taping a wound can work really well. Remember each time you get out of the sea that you’ll need to clean the wound again and apply antiseptic. I’ve found that using tape isn’t really that effective for closing wounds, more just keeping it clean and preventing it getting worse.

Taping around a joint works well to keep the wound closed and helps keep it in place when in the sea. Be carefull not to tape too tight so you don’t cut of the blood supply to the wound, or the arm!

Tape is best used to keep dressings in place.

Staples

These are really good for closing skin. They place the skin together nicely and they don’t put the skin under too much tension. A potential problem with sutures.

Take them out the same time you would take sutures out.

 

 

Sutures       Stich up

Only suture if you are happy to do so.

There are loads of videos out there to remind you of how to do it:

Most effective way of closing a wound.

Only suture wounds that are clean and fresh (less than 12 hours old)

Deep wounds should be closed by professionals.

Use non-absorbable sutures. Ethilon 5 for the face, neck, ear or hands. Ethilon 3 or 4 for cuts anywhere else.

The sutures need to be removed after time.

Foot: 10 – 14 days

Arm or Leg: 7-10 days

Scalp: 5 days

Face: 4 days

Torso: 1 week

Don’t pull the sutures too tight. This will cut off the blood supply to the tissue around the sutures and prevent healing.

Good luck!

NECK WOUNDS

You’d be unlucky to get a neck wound from surfing, but its not that unusual from car & bike accidents.

Bear in mind that your neck contains lots of important stuff! Don’t go poking around inside a deep wound trying to have a good clean. This should be done by a surgeon in a hospital. Clean the outside carefully but don’t go inside! Wounds that are clearly just on the surface can be cleaned normally.

Dressings– NEVER bandage around the neck. Swelling can increase pressure and close the airway.. Suffocation isn’t always obvious.

Author: Dr Dave Baglow

Download this article here

Disclaimer

There is no substitution for being examined and treated by a medical professional. The intention of the articles on this website is to inform anyone who reads it of medical issues encountered on surf trips.This website is designed to provide general practical information not specific medical advice.

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6 Trackbacks / Pingbacks

  1. SURF TRIP KIT LIST « getswellsoon.com
  2. ANTI-BIOTICS « getswellsoon.com
  3. REEF CUTS « getswellsoon.com
  4. LITTLE URCHIN « getswellsoon.com
  5. KNOCK OUT! « getswellsoon.com
  6. SPINE « getswellsoon.com

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