Skin Injuries

Yvonne Brault, M.D, contributing editor, American Rose, July/August 2019

WITH ANY ACTIVITY as intense as rose gardening, injuries to the skin are inevitable. A laceration to the skin can ruin a gardening experience or send you to the ER and ruin your day. Proper care can enhance healing and prevent worsening. Offered here are some general guidelines to help you decide when to seek medical attention. When in doubt, be seen!

• A cut longer than 2-3 cm (about an inch) and through all layers of skin will probably need stitches. Get them. Sutures generally need to be placed within six hours of acquiring an Injury.

• Wounds overlying bending joints will probably not stay closed long enough to heal as they wiII break open every time you bend the joint. Get them sutured to heal them properly. Any wound which may be into a joint needs to be evaluated.

• Any injury which may have entered a joint space or is deep in the palm or on the face needs special medical attention. Be evaluated. If you are worried about the cosmetic appearance of a healed wound, be seen.

• See a physician if you are not up to date on your tetanus. Most gardening activity injuries are dirty wounds which are tetanus prone. If you are outside and near dirt your wound may contain the tetanus germ Clostridium tetani. Not only does a laceration need washing with soap and water (ALL CUTS NEED IMMEDIATE WASHING WITH SOAP AND WATER) but you also need to make sure your tetanus immunization is up to date. If you have a clean wound you need a booster shot every 10 years. If you have a dirty wound like gardeners get, you need a booster if it has been five years since your last immunization. Tetanus infection (commonly known as lockjaw) is very serious and prevents muscles from contracting normally. It can ultimately be fatal, but is usually easily prevented with immunization.

• If it has been MANY years since you had a booster shot (you cannot remember how many decades) or if you never had the immunization series as a child, your doctor will need to inject preformed antibodies to tetanus into the area to help prevent tetanus infection. If you have not been immunized at all you will also need to complete tetanus immunization after the initial boost of immunity.

• See a physician if a serious wound has gross dirt or particulate matter. Just plain washing may not be enough to clean the wound properly. You may need pain management (local anesthesia) for adequate cleansing.

• If you have ongoing bleeding, apply direct pressure to the wound to stop it. If you have done this for several minutes and as soon as you let up it begins to bleed again, you probably need stitches.

• Step-on injuries can be infection prone not only if they are puncture wounds, but because while healing they come into contact with our dirty shoes and what we walk on. If something sharp cuts you through your shoe, you need antibiotics. If you have a puncture wound, by definition they are deeper than they are wide, and it is nearly impossible to adequately clean the wound. Soak your foot in warm soapy water two-to-three times daily to prevent crusting and help healing. See your doctor for any concerns. You may need antibiotics depending on the wound.

• If there is any concern about damage to a bone combined with a skin injury, you need to be evaluated.

• Any break in the skin can result in cellulitis, or localized infection. Watch for signs like worsening redness, swelling, warmth, pus, pain or numbness, or a fever. See your doctor for further wound care or antibiotics. See your physician immediately if you notice a red streak leading up your arm or leg, as this is a sign of spreading infection (lymphangitis).

Skin injuries may be preventable by using properly maintained tools, wearing gloves and proper footwear (not flip flops), removing obstacles in pathways, utilizing good fall prevention techniques, etc. Cut away from yourself when opening that new box of bare-root roses or your new gardening tool! Stay healthy in the garden!