Lacerations Contusions and Injuries in Accidents and Personal Injury Cases
In just about every personal injury accident, one or more of the persons involved will suffer “lacerations and contusions,” which are the fancy medical and legal terms for cuts and bruises. But lacerations and contusions should not be written off as minimal nuisance injuries that heal in a short time. For example, lacerations inflicted by a pit bull on a person’s face are extremely painful and disfiguring. Contusions to the brain resulting from a blow to the head can result in a traumatic brain injury (TBI). Concerns when you suffer a laceration include bleeding, infection, pain, damage to structure beneath the skin, and future scars. A deep cut may expose underlying tissues, such as fat, tendon, muscle, or bone.
Lacerations and contusions to the head can be potentially deadly, even if the impact was not that great and the observable injuries do not appear to be severe. The lacerations and contusions may cause a hematoma (either a subdural or an epidural hematoma), causing heavy bleeding into or around the brain. Two other types of open wounds are commonly found in personal injury cases: abrasions and puncture wounds. An abrasion is a superficial wound in which the uppermost layer of the skin (the epidermis) is scraped off, often by a sliding fall on a rough surface. A puncture wound is usually caused by a sharp pointy object such as a nail, animal teeth (such as a dog bite), or a tack. This type of wound usually does not bleed excessively and can appear to close up. Puncture wounds are prone to infection and should be treated appropriately.
A laceration is a jagged and irregular cut produced by tearing of soft body tissue caused by some blunt trauma, such as being hurt in an automobile accident or a fall. The seriousness of a laceration depends on its location, its depth, whether it leaves a foreign body inside the wound, the amount of blood loss, and whether the cut becomes infected. A laceration is known as an “open wound.” An X-ray may be taken if foreign objects or an underlying broken bone is suspected.
A tetanus shot may be required when a person has suffered a laceration, puncture wound, abrasion, or other injury that breaks the skin. If the laceration was inflicted by a dog, you should verify that the dog was current in its rabies shots; otherwise you will have to undergo a painful series of anti-rabies shots.
For mild lacerations with no complications, medical treatment generally is not called for. All that is required for treatment is to wash them with soap and tap water and keep them clean and dry. Putting alcohol, hydrogen peroxide, and iodine should not be avoided, as this can delay healing.
Medical attention for a laceration may be required where:
The wound spurts blood, blood soaks through the bandage, or bleeding continues after ten minutes of firm pressure
The laceration is longer than 1/3rd of an inch or covers a large part of the body
Pus drains from the cut
There is warmth or numbness in the area of the cut or swelling around it
The cut is jagged, appears deep, or is located on the face, head, or hand
The cut was caused by a dirty or rusty instrument
The wound becomes tender or inflamed
The person cannot move comfortably or develops a temperature over 100 degrees Fahrenheit
The wound fails to heal
There are signs of nerve or tendon injury, such as numbness in the area of the wound
The goals of laceration treatment are to stop the bleeding, avoid infection, restore function to the involved tissues, and achieve optimal cosmetic results with minimal scarring. While emergency rooms routinely treat acute trauma involving lacerations, the family doctor should be prepared to treat acute lacerations. This requires knowledge of wound evaluation, preparation, and appropriate repair techniques, as well as when to refer the patient for surgical treatment and how to provide follow-up care.
When a person goes to a doctor or emergency room for treatment of a laceration, the laceration should be carefully evaluated to assess its severity and the involvement of muscle, tendons, nerves, blood vessels, and bone. Direct pressure should be applied to control bleeding. The history should include when and how the injury occurred and personal information, such as a history of hemophilia, HIV, diabetes, tetanus immunization, and allergies to latex, local anesthetics, tape, or antibiotics. The patient should be instructed on signs of infection and when follow-up should be performed.
Referral to a surgeon is appropriate in cases of deep wounds to the hand or foot full-thickness lacerations of the eyelid, lip, or ears; lacerations involving nerves, arteries, bones, or joints; penetrating wounds of unknown depth; severe crush injuries; severely contaminated wounds requiring drainage; and wounds for which the victim or the doctor is strongly concerned about the cosmetic outcome.
If you were injured in, say, a traffic accident caused by another person, that resulted in serious lacerations that needed stitches or other medical intervention and left a scar, you are entitled to receive compensation for the disfigurement. Of course, your monetary recovery will be much greater for a long scar on your face than a small scar on your arm, back, or leg.
Infection is the biggest medical concern in the first few weeks following a laceration or other “open” injury. Signs of infection include severe pain, draining pus, redness beyond the wound edges, fevers and chills, or excessive wound swelling. If you think you have an infection, you should seek prompt medical care.
Scarring is also a major concern. Although good wound care gives the best chance of a smaller scar, there are several factors beyond your control. For instance, jagged cuts with more traumatic skin damage (such as a cut surrounded by an area of abrasion) tend to scar more. African-Americans tend to form “keloid scars” during the healing process. A keloid is a thick swollen care with a ropelike quality, which can sometimes be treated by a dermatologist or plastic surgeon after the wound is healed.
You can help to minimize the possibility of scarring by watching for signs of infection (such as redness, swelling, oozing pus) and seeing your doctor promptly. You should also avoid sun exposure, as newly healed tissue burns more easily and is often left discolored. A scar will often look red and swollen after removal of the sutures, but may fade considerably over the next year.
A contusion is caused when tiny blood vessels (“capillaries”) are damaged or broken as the result of blunt trauma to the skin, crushing the underlying muscle fibers and connective tissue without breaking the skin. A contusion is classified as a “closed wound.” A bruise results from blood leaking from these injured blood vessels into tissues as well as the body’s response to the injury. A purplish, flat bruise that occurs when blood leaks out into the top layers of skin is referred to as an “ecchymosis.”
While contusions often affect only the tissues just beneath the skin, severe impacts can cause serious contusions in muscles, bones, or even internal organs. In severe cases, swelling and bleeding beneath the skin may cause shock. If tissue damage is extensive, you may also have a fractured bone, dislocated joint, sprain, torn muscle, or other injury. Severe injuries that cause difficulty in moving a limb, abdominal bruising, bruising behind the ear, and the feeling of liquid under the skin may indicate a life-threatening injury and requires immediate medical care.
In some cases, built-up pressure from fluids several hours after a contusion injury can disrupt blood flow and prevent nourishment from reaching the muscle group. This is known as “compartment syndrome,” and often requires urgent surgery to drain the excess fluids. Untreated compartment syndrome can result in tissue necrosis, permanent functional impairment, and, if severe, kidney failure and death. Compartment syndrome can occur wherever a compartment is present: the hand, forearm, upper arm, abdomen, buttock, and entire lower extremity (the legs). In compartment syndrome, the patient complains of deep, constant, and poorly localized pain, and is often described as out of proportion with the injury. Compartment syndrome is a serious medical condition requiring emergency care.
Sometimes a bruise does not go away and instead becomes firm and may actually start getting larger in size. It may also continue to be painful. If a large collection of blood is formed under the skin or in the muscle, rather than trying to clean up the area, the body may wall off the blood that is causing a hematoma. A hematoma is a small pool of blood that is walled off and may need to be drained by your doctor.
You should take photographs of your bruises at their worst so they can be shown to the jury to help to demonstrate the extent of your injuries. Call now and talk to a lawyer for free about your case: 310.882.6810