Puncture Wound

• 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.

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 occurs
• 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

Care Advice for Puncture Wound

1. What You Should Know About Puncture Wounds:
   • Most puncture wounds do not need to be seen.
   • Here is some care advice that should help.
2. 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.
3. Antibiotic Ointment:
   • Use an antibiotic ointment (such as Polysporin). No prescription is needed.
   • Then, cover with a bandage (such as Band-Aid). 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.
4. 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.
5. What to Expect:
   • Puncture wounds seal over in 1 to 2 hours.
   • Pain should go away within 2 days.
6. 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

Care Advice for Puncture Wound

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.