SOFT-TISSUE INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 171

flaps may be moist, foul smelling, and soft. Surgical excision and grafting are required for
both, and the infection can be life threatening.
Small skin flaps with little or no fat on the undersurface are an entirely different matter.
Thewoundsmustbecleanedandtheflapsheldsecurelyinpositionbybulkybandagesjust
as larger flaps are, but such wounds often heal with no complications or severe infection.
The skin flaps commonly do not reattach to the underlying tissue, but they protect the del-
icatenewskinthatgrowsinfromthesidesandallowittocoverthewound.Bythetimethe
woundiscovered,theflapusuallyhasdriedupandfallenoff.Thenewskinmayneedtobe
protected for a few days, but no further therapy is required. (A ruptured blister could even
be considered a small skin flap for which the full thickness of the skin is not removed.)
Contusions
Contusions, or bruises, are crushing injuries that cause bleeding into damaged tissues.
Usually the subcutaneous tissue and muscle are injured without a break in the overlying
skin.Thevast majority ofcontusions areminor,almost insignificant injuries, butrarely the
damage can be great enough to severely incapacitate the individual.
The ideal treatment for a severe contusion is described by the mnemonic ICE:
I Immobilization
C Cooling, preferably with snow or ice
E Elevation
Ideally, such therapy should be given immediately and should persist until bleeding has
ceased. However, such treatment may be impractical—even life threatening—in some cir-
cumstances. Complete cessation of bleeding usually requires six to eight hours, but by that
time the muscles may be so stiff and sore the person cannot walk. Anyone with a severe
contusion in a remote area may need to walk out, or at least back to camp, while still able
to do so. After the muscles have stiffened, they often are too painful for vigorous exercise
for three or four days, and weeks may be required for complete recovery.
If circumstances do not require immediate evacuation, the injured area should be elev-
atedandcooledwithsnow,ice,orwettowelsorclothing,anyofwhichwillcauseconstric-
tion of blood vessels in the area, reduction of bleeding into the tissues, and lessening of
pain.(Coolinghastensdisablingmusclepainandstiffnessandshouldnotbeusedforlower
extremity injuries if the person must be able to walk.) If extensive swelling develops, the
extremity may be wrapped with an elastic bandage that applies mild pressure. The wrap-
ping should encompass the entire limb from the toes (or fingertips) to well above the area
of injury but must not occlude circulation.
Aftertwelvehours,movement oftheinjuredareamayberesumed,iftolerated, tospeed
resorption of the blood. After three days, heat may be applied to accelerate blood resorp-
tion and to diminish muscle pain.