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Puncture Wound

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Definition

  • The skin is punctured by a pointed narrow object

Causes of Puncture Wounds

  • Metal: nail, sewing needle, pin, tack
  • Pencil: pencil lead is actually graphite (harmless). It is not poisonous lead. Even colored leads are not toxic.
  • Wood: toothpick

Complications of Puncture Wounds

  • Retained Foreign Object. This happens if part of the sharp object breaks off in the skin. The pain will not go away until it is removed.
  • Wound Infection. This happens in 4% of foot punctures. The main symptom is spreading redness 2 or 3 days after the injury.
  • Bone Infection. If the sharp object also hits a bone, the bone can become infected. Punctures of the ball of the foot are at greatest risk. The main symptoms are increased swelling and pain 2 weeks after the injury.
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When To Call

Call 911 Now

  • Deep puncture on the head, neck, chest, back or stomach
  • You think your child has a life-threatening emergency

Go to ER Now

  • Bleeding that won't stop after 10 minutes of direct pressure
  • Puncture on the head, neck, chest, or stomach that could be deep
  • Tip of the object broke off in the body

Call Doctor or Seek Care Now

  • Puncture into a joint
  • Feels like something is still in the wound
  • Won't stand (bear weight or walk) on punctured foot
  • Needlestick from used needle (may have been exposed to another person's blood)
  • Sharp object or setting was very dirty (such as a playground or dirty water)
  • No past tetanus shots. Note: tetanus is the "T" in DTaP, TdaP, or Td vaccines.
  • Dirt in the wound is not gone after 15 minutes of scrubbing
  • Severe pain and not better 2 hours after taking pain medicine
  • Wound looks infected (spreading redness, red streaks)
  • Fever
  • You think your child has a serious injury
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Last tetanus shot was more than 5 years ago
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Minor puncture wound
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Care Advice

What You Should Know About Puncture Wounds:

  • Most puncture wounds do not need to be seen.
  • Here is some care advice that should help.

Cleaning the Wound:

  • First wash off the foot, hand or other punctured skin with soap and water.
  • Then soak the puncture wound in warm soapy water for 15 minutes.
  • For any dirt or debris, gently scrub the wound surface back and forth. Use a wash cloth to remove any dirt.
  • If the wound re-bleeds a little, that may help remove germs.

Antibiotic Ointment:

  • Use an antibiotic ointment (such as Polysporin). No prescription is needed.
  • Then, cover with a bandage. This helps to reduce the risk of infection.
  • Re-wash the wound and put on antibiotic ointment every 12 hours.
  • Do this for 2 days.

Pain Medicine:

  • To help with the pain, give an acetaminophen product (such as Tylenol).
  • Another choice is an ibuprofen product (such as Advil).
  • Use as needed.

What to Expect:

  • Puncture wounds seal over in 1 to 2 hours.
  • Pain should go away within 2 days.

Call Your Doctor If:

  • Dirt in the wound still there after 15 minutes of scrubbing
  • Pain becomes severe
  • Looks infected (redness, red streaks, pus, fever)
  • You think your child needs to be seen
  • Your child becomes worse

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Photos

Puncture Wound - BB Gun

This photo shows a puncture wound from a BB gun in the upper arm. Note the small hole in the arm where the BB struck and entered the skin.

Source: Self Care Decisions, LLC
Used with Permission from Schmitt Pediatric Guidelines LLC.

Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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