Open Wound Due to Trauma

First aid for an open wound

1. Protect yourself. Wear gloves if available, or use a clean barrier.
2. Stop the bleeding. Press firmly with a clean cloth or gauze for a full 10 minutes without lifting to check. If blood soaks through, add more cloth on top. Raise the injured part above the heart if possible.
3. For severe limb bleeding that does not stop with pressure, apply a tourniquet 5 to 8 cm (2 to 3 in) above the wound if one is available, and note the time.
4. Clean the wound. Rinse under clean running tap water for several minutes. Wash the surrounding skin with soap, but avoid getting soap deep in the wound. Remove small surface dirt with tweezers cleaned with alcohol.
5. Do not use hydrogen peroxide, iodine or alcohol inside the wound. They damage tissue and slow healing.
6. Cover it. Apply a thin layer of petroleum jelly or antibiotic ointment, then a non-stick dressing.
7. Check tetanus status and decide whether you need medical care (see triage above).

Types of traumatic wounds

Head wounds: "cracked head open" injuries

The scalp has a rich blood supply, so even small cuts bleed heavily and look alarming. A "split" or "cracked open" head usually means a scalp laceration, not a broken skull. Still, any head wound needs a check for brain or skull injury.

• Press firmly with a clean cloth for 10 minutes. Avoid pressing hard if you feel a soft or dented area of bone; press gently around the edges instead.
• Go to the ER or call 911 for loss of consciousness, confusion, repeated vomiting, severe headache, drowsiness, seizures, unequal pupils, clear fluid from the nose or ears, or bruising behind the ears or around both eyes. These suggest a head injury or skull fracture.
• Scalp cuts are often closed with staples, stitches, or by tying hair across the wound with skin glue.
• People on blood thinners and older adults need assessment after any significant head blow, even if they seem well.

More detail is on our page on open wounds of the head.

When an open wound needs medical care

Signs it needs closing

• The edges gape or pull apart when you move
• It is deeper than about 6 mm (1/4 in), or you can see yellow fat, muscle or bone
• It is longer than about 1.3 cm (1/2 in) on the face, or 2 to 3 cm elsewhere
• It is on a joint, hand, face, lip edge or eyelid
• It keeps bleeding after 10 minutes of pressure

Wounds are best closed within about 6 to 8 hours. Clean face and scalp wounds can often be closed up to 24 hours. Older, dirty or bite wounds are often left open or closed later to reduce infection.

What the doctor will do

• Examine for damage to tendons, nerves and blood vessels by testing movement, feeling and circulation
• X-ray for fractures or foreign bodies such as glass or metal
• Numb and irrigate the wound with large amounts of saline
• Close it with stitches, staples, skin glue or adhesive strips, or leave it to heal open
• Give a tetanus booster if needed, and tetanus immune globulin for dirty wounds in people never fully vaccinated
• Prescribe antibiotics for bites, heavily contaminated wounds, open fractures and people at high risk of infection. Most clean wounds do not need them.

Tetanus protection

Tetanus bacteria live in soil and dust and enter through wounds, especially punctures and crushed or dirty tissue. You need a booster if:

• the wound is clean and minor and your last tetanus shot was more than 10 years ago
• the wound is dirty, a puncture, a bite, a burn or crushed and your last shot was more than 5 years ago
• you have never had the full childhood series or do not know

Caring for the wound at home

• Keep the wound covered and moist with petroleum jelly or ointment; moist wounds heal faster with less scarring.
• Change the dressing daily or when wet or dirty.
• Gently wash with clean water once or twice a day after the first 24 to 48 hours.
• Stitches usually come out after 3 to 5 days on the face, 7 to 10 days on the body and arms, and 10 to 14 days on hands, feet and over joints.
• Protect the healing scar from sun for 6 to 12 months to reduce darkening.

Signs of wound infection

Watch for these over the next few days:

• Increasing pain, swelling, warmth or redness, especially redness spreading out from the wound
• Pus or cloudy, smelly drainage
• Red streaks running up the limb
• Fever or chills
• Swollen, tender lymph nodes in the armpit or groin

These need prompt care. See infected open wounds for more on treatment.

Frequently asked questions

How do I know if a wound needs stitches?

A wound probably needs stitches if it gapes open, is deeper than about 6 mm (1/4 in), shows fat or muscle, is on the face, a joint or the hand, or keeps bleeding after 10 minutes of firm pressure. Get it checked within 6 to 8 hours for the best result.

What should I do if someone cracks their head open?

Press a clean cloth firmly on the wound for 10 minutes. Call 911 if they lost consciousness, are confused, vomit repeatedly, have a seizure or have fluid from the nose or ears. Even without these, most deep or gaping scalp wounds need closing at an urgent care center or ER.

Should I put hydrogen peroxide on an open wound?

No. Hydrogen peroxide, alcohol and iodine damage healthy tissue and slow healing. Rinse the wound with clean running tap water for several minutes, then cover it with petroleum jelly or antibiotic ointment and a clean dressing.

Do I need a tetanus shot for a cut?

You need one if your last tetanus shot was more than 10 years ago for a clean, minor cut, or more than 5 years ago for a dirty, puncture, crushed or bite wound. If you are not sure, it is safer to get a booster.

How long does an open wound take to heal?

Small cuts and scrapes usually heal in 1 to 2 weeks. Larger or stitched wounds close within 1 to 3 weeks, but the scar keeps strengthening and fading for 12 to 18 months. Diabetes, smoking, infection and poor circulation slow healing.