Puncture Wounds

Puncture wounds are wounds that are deeper than they are wide. These can be deceptive because they look small on the outside and may not bleed much. But they usually need medical attention. And sometimes, they need emergency care.

Types of puncture wounds

Puncture wounds come in different forms:

• Penetrating injuries: These injuries go through your skin to the tissues underneath. Depending on where they are and how deep they go, puncture wounds can be very serious.
• Perforating injuries: This is when something pierces and goes all the way through your body. It leaves entry and exit wounds. Fast-moving objects like bullets are a common cause.
• Impalement: This is when you have a penetrating injury, and whatever caused the injury is still lodged in your body.

IMPORTANT: DO NOT pull out an impaling object. It could cause more damage or dangerous bleeding.

Symptoms of puncture wounds

Puncture wounds often cause immediate symptoms like:

• Bleeding: Punctures tend to bleed more when they affect areas with a lot of blood flow. Your face and scalp are key examples of at-risk places that can bleed a lot. But punctures can also bleed heavily if they’re near major blood vessels, like in your neck, chest or groin.
• Pain: Punctures usually hurt. The more sensitive the spot, the more it hurts. Examples include your fingertips, face and the soles of your feet. Punctures in vital areas — like your chest or abdomen — can also hurt a lot, especially when they’re deeper.

Puncture wound causes

There are several ways that you can get puncture wounds. They can happen with objects that are sharp, moving very fast or that have a lot of force behind them. Some examples of puncture causes include:

• Bites and stings: Animals like cats and dogs commonly cause punctures with their bites. Human bites cause them, too. And you can get punctures from other animals like snakes, spiders, scorpions and even some types of fish.
• Plants: Thorns or spines on plants are a common cause of skin punctures. And splinters are punctures from shards of wood.
• Tools: Punctures are common when you work with tools, especially power tools. Nail and staple guns can easily cause these injuries. And debris like nails can puncture your foot. Sometimes, that happens right through the sole of your shoe.
• Simple household items: Safety pins, sewing needles and thumbtacks can all puncture your skin.
• Weapons: Sharp objects like knives and fast-moving objects like bullets are common causes of puncture wounds.

Complications of puncture wounds

Puncture wound complications can include:

• Infections: Your skin is your body’s best defense against germs, and punctures let germs enter easily. That makes infections the most likely complication of a puncture. And in severe cases, debris left behind can lead to dying tissue or spreading infections and sepsis.
• Bleeding: This can be dangerous if a puncture is deep and close enough to a major blood vessel.
• Internal injury: Deeper penetrating injuries can damage vital organs inside you, like your heart.
• Permanent damage and loss of function: Puncture wounds can damage some body parts permanently. One example of this would be open globe injuries to your eyes and the potential for vision loss or blindness.
• Scarring: Puncture wounds can leave behind scars after they heal, even with medical care.
• Death: Any of the above complications can be deadly.

How doctors diagnose puncture wounds

Puncture wounds leave a visible injury on your skin. Healthcare providers can find that with a physical exam, and they may also ask you questions about how and when your injury happened.

Imaging tests may be necessary when there’s a chance that something is left behind in a puncture or penetrating wound. Possible tests include:

• X-ray
• CT scan
• Ultrasound

Your provider may also recommend certain types of tests to check for infections or determine how to treat them. Bacterial culture tests are an example. Your provider can use these tests to look for an infection and find out what bacteria are causing it. They can then use the results to pick which antibiotic to prescribe.

How are puncture wounds treated?

The treatments for puncture wounds depend on many factors. Those include:

• Location of the wound
• Size and depth of the wound
• What caused the wound
• If there is or might be something left behind in the wound
• How long ago the injury happened
• Your health history

Some of the most likely treatments for puncture wounds include:

• Numbing: Your provider may use a local anesthetic to numb the area around the injury. That way, you won’t feel pain as they examine and treat it.
• Cleaning: Your provider will clean the skin around the puncture and try to wash out (irrigate) the injury. They might use saline solution and disinfectants like iodine.
• Exploring: Your provider will check inside the puncture to see how severe it is. They’ll also make sure there’s nothing left from whatever caused the injury.
• Repair: If you have internal injuries, your provider may need to repair the damage. That can happen with stitching, surgery or other treatments.
• Closing or covering: Your provider will try to close the wound, if possible. But with punctures, that’s not always an option. In many cases, covering the wound with a bandage is the best option. That will keep it clean and keep germs and debris out.
• Protective care: Your provider may prescribe antibiotics to prevent a bacterial infection. They might also vaccinate you against deadly diseases like tetanus or rabies.

Recovery time

The recovery time for a puncture wound depends on the same factors that determine treatment. Small punctures might heal within days. Larger ones might take weeks or even months to fully heal. Your healthcare provider can tell you what to expect in your case.

What kind of first aid should I do on a puncture wound?

If you have a puncture wound, you can do the following first aid:

1. Stop the bleeding. Using a bandage, gauze or a clean cloth, press directly on the wound. Hold the pressure for at least five minutes.
2. Clean the injury. Use soap and warm water to clean the wound. Don’t use alcohol, peroxide or iodine on the injury.
3. Bandage the injury. This needs to last until you can get professional care. It’ll keep debris and other harmful things out until then.

When should I seek care?

Puncture wounds usually need professional medical care. Sooner is better than later. The ideal window for treating minor puncture wounds is within six hours of the injury. An urgent care or clinic can often treat minor puncture wounds, like a splinter you can’t get out on your own.

You should go to an emergency room for punctures or penetrating injuries when they:

• Are on your face, head, chest or abdomen, or are near your genitals
• Are near a major blood vessel, or if pressing directly on the wound for several minutes doesn’t stop the bleeding
• Go deep enough that you can see tissue under your skin, like subcutaneous fat, muscle, bones, etc.
• Pass all the way through part of your body
• Are from any kind of projectile
• Are from any kind of bite
• Feel like there might still be something in the wound
• Are on the sole of your foot, especially if the puncture happened through your shoe
• Could have dirt or debris inside the wound

If you aren’t sure whether a puncture wound needs professional care, it’s best to err on the side of caution. Your healthcare provider would rather you get care for something less serious than wait too long for something severe.

What can I expect if I have a puncture wound?

What you can expect from a puncture wound varies. Your healthcare provider can tell you what to expect in your case. They can also tell you how to care for the injury as it heals.

If you get treatment for a puncture wound, keep tabs on how it feels. If it hurts just as much or worse 48 hours after you get treatment, call your healthcare provider or get medical care. And if you develop pain around the site of a puncture wound, even days or weeks later, get medical care. Some deep infections, like bone infections, can take a long time to cause symptoms.