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Puncture wound Treatment

A puncture wound is a wound deeper than it is wide which penetrates the epidermis. Usually puncture wounds are small and do not include more serious wounds such as stab or gunshot wounds.

These wounds receive different medical consideration than other wounds for several reasons:

  • The full depth of the wound is usually not visible making assessment of damage to deeper structures such as bone or body cavities (chest, bowels, bladder, joint, etcetera) more difficult.
  • The assessment for possible presence of a retained foreign body is more difficult (i.e. is a piece of the penetrating object still in the body under the skin?).
  • Cleansing of the wound may be difficult or impossible.
  • If infected, puncture wounds do not drain well, making the infection more serious.
  • There is a tendency for these wounds to be overlooked by the individual because of the relatively innocuous surface appearance.

Special considerations

Tetanus prophylaxis should be considered in all cases of puncture wound. The need will be dictated by the nature and cleanliness of the penetrating object, the depth of penetration, as well as the immunization status of the child.

Some special considerations may be related to the nature of the penetrating object. Common objects causing puncture wounds includenails, barbed wire, animal bites, kitchen utensils, writing implements, glass, wood and thorns. Nails, being strong and sharp, may penetrate though shoes and carry bacteria from the shoe into the foot. Animal bites may prompt consideration of post exposure prophylaxis for rabies. Glass and wood may break and leave material within the wound prompting widening and exploration of the wound. Kitchen utensils may be contaminated with potentially unusual infectious material from raw meat or fish. Thorns may deposit fungi beneath the skin. In some of these cases, oral antibiotics will be administered. In other cases, observation is sufficient. It is important to call your child’s physician if your child has a puncture wound.

Other special consideration may be related to the site of the puncture wound. Intravenous antibiotics and/or the involvement of specialists may be indicated for puncture wounds in or around the eyes, joints, chest, abdomen and neck. In other areas consideration must be made as to whether or not any bone, nerve, or blood vessel injury has taken place.