SOFT-TISSUE INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 169

needed, porous tape should be used to hold the bandage in place. When the bandage is
changed, the tape can be clipped off at the skin edges and new tape placed on top of the
old to avoid the skin irritation that results from repeatedly stripping off the tape.
SPECIFIC INJURIES
Lacerations
Lacerations are slicing injuries that may be clean and straight or ragged. Such wounds
commonlybleed.Infectionsarealsoathreat,particularlywhensmalltagsofdeadtissueare
presentinraggedwounds.Bloodvessels,nerves,ortendonsmaybedamaged,butattempts
to repair such structures outside of a hospital would cause further damage and increase the
risk of infection. Individuals with such severe injuries should be evacuated.
Puncture Wounds
Apuncturewoundmayextenddeeplyintounderlyingtissues.Hiddenstructuresmaybe
damaged, and infection is always a threat. Bleeding to wash out dirt and bacteria should be
encouraged.Foreignbodiesshouldberemoved.Asmallwickofgauzecanbeinsertedinto
the opening of the wound to prevent sealing and to allow the exudate from any infection
to drain to the outside, although no evidence supports the value of this logical procedure.
Antibiotic therapy has not proven beneficial except for animal bites.
The greatest danger from such wounds is tetanus, which should be prevented with
tetanus toxoid inoculations well before an outing is even contemplated.
Abrasions
Abrasions are scraping injuries produced by forceful contact with a rough surface.
Severe bleeding is rare and the objectives of treatment are to control infection and promote
healing. Before bandaging, large fragments of foreign material should be removed from
the wound with sterile forceps. Removing numerous small embedded particles is painful,
may aggravate the injury, and can do more harm than good; many such particles are ex-
truded during healing, and the rest can be removed under more propitious circumstances.
(In emergency departments, such wounds are anesthetized by applying lidocaine jelly and
scrubbing away the particles.)
The wound should be covered with a layer of nonadherent material such as gauze im-
pregnated with petroleum jelly, over which should be placed a bulky dressing to absorb
drainage and cushion against further trauma. During dressing changes, the inner layer
should not be removed until it spontaneously separates from the wound surface. Similarly,
crusts that form during healing should not be removed.
Infected abrasions usually produce purulent exudate, but the entire wound is open and
drainage is not impaired. Dressings should be changed frequently and should be thick
enough to absorb the exudate.