Basketball Scrapes and Infection

About 7 years ago I had a serious staph infection on my knee that became serious enough that it did not respond to 4 different types of strong antibiotics, was swollen larger than a volleyball, and was very hot to the touch due to the fever and infection.  Preliminary discussions about hospitalization and possibly surgery and even amputation really scared me straight and forced me to take it very seriously.    Since that time I have shared warnings about staph with my players but here is a quick review of how to deal with the inevitable scrapes and scratches we get in basketball.

To clean the wound:

• Rinse the wound with running water.
• Remove any foreign material in the wound (such as dirt, gravel or glass) by using tweezers if necessary.
• Ideally, clean the wound with a sterile gauze.  Basketball players should have a tiny first aid kit in their gym bags with gauze, antiseptic wipes, antibiotic (Neopsorin), and a ice pack.
• Don’t use a T-shirt etc. to clean it if possible.
• If the bleeding restarts, apply the gauze firmly and press.

When your patient should seek medical help

If you cannot to remove all foreign objects (like asphalt from a court)  they should seek medical help in thoroughly cleaning the wound.  My wife Heather had some sort of object appear in her hand years after probable entry thru road rash during a jogging accident.  She did get her hand cleaned professionally and that is so painful, but the screen cleaning she received paled in comparison to the surgery and pain whe went thru later.

SHOULD I GO TO THE DOCTOR/ER

Scrapes often cover large areas, but they are superficial. When caring for a scrape, make sure to remove any embedded grit or dirt.

Small cuts can be cared for at home if the edges of the cut are close together. Make sure to remove any foreign material from the cut, stop the bleeding and cover the cut with a bandage or dressing.

When your patient should seek medical help

Your patient may need to seek medical attention for a cut or scrape if:

• The wound needs sutures. A wound needs sutures if it is deep, if fat protrudes from it, if the wound is over half an inch long or if it is a gaping wound.
• Your patient is unable to remove dirt, debris or dead tissue.
• Your patient can’t stop the bleeding.
• The wound is a puncture.
• The wound occurs on the face, eyelids, lips, or neck.
• The edges of the wound are badly torn
• A tetanus shot is required.
• Your patient is uncomfortable or unable to deal with the situation.

Options for closing wounds

There are many ways to close wounds, and the best option will depend on the type and severity of the wound itself.

Skinstrips are tape-like strips that hold the skin together. These are appropriate for small cuts that occur on parts of the body where there is very little tension or movement that could pull the wound apart (e.g. torso, thigh).

For deeper cuts, stitches (or sutures) are used to sew the edges of the cut together. They are very useful for closing wounds that have occurred on parts of the body where there is a lot of movement (e.g. hands).

Steri-strips are used to close wounds on the face in those instances where stitches may leave a scar. Steri-strips or butterfly strips are thin and sticky, and usually fall off after a few days.

Skin glue is a special adhesive that sticks together the edges of the wound and seals the skin for protection. Skin glue is not as effective on areas where there is a significant amount of skin movement.

Prevent infection

Once you have stopped the bleeding and cleaned the wound, you will want to prevent infections from developing. The most effective strategy is to apply a topical antibiotic to the wound and cover it with a dressing.

You can help prevent infection by:

• Applying a topical antibiotic, such as Bactroban, Fucidin or Polysporin to the wound. Topical antibiotics should be applied with each dressing change, or two to three times a day if the wound is left uncovered.
• Cover the wound to keep it moist and to protect the topical antibiotic.

Studies show that applying a topical antibiotic can promote healing in eight days, as opposed to 13 days for wounds left untreated. The use of mercurochrome and tincture of iodine was not as effective. These products resulted in healing over 13 and 15 days respectively.

Promote healing

You can promote healing and minimize the potential for scarring by covering the wound. Scientific studies show that keeping an injured area moist:

• promotes the growth of new tissue,
• lessens the potential for infection,
• minimizes scarring, and
• lessens the chance of further injury to the cut or scrape.

Many different sizes and types of wound dressings are available. Dressings should be changed daily or when they become wet or dirty.

Although covering a wound is generally the best choice, there are times when it’s appropriate to leave a wound uncovered. A scrape on a knee or elbow, for example, can often be left to heal uncovered after cleaning and applying a topical antibiotic.

Identifying secondary infection

You should examine the wound carefully to ensure that secondary infection has not developed. Signs of infection generally emerge a few days after the injury and include:

• red, swollen or warm skin surrounding the wound
• discharge and pus from the cut or scrape
• a red line moving up the limb from the wound
• fever.

If your patients suspect secondary infection, they should seek medical help.

Medical help for secondary infections

If your patient seeks medical attention for a secondary infection of a cut or scrape, the doctor may swab the wound for bacteria.

Staph infections are the most common bacterial infections, and can lead to impetigo elsewhere on the skin. Prescription and over-the-counter topical antibiotics have been shown to be as effective at treating localized infections as oral antibiotics – and they have fewer side effects.

Strep infections are often indicated by a red line (lymphangitis) leading from the wound. Strep infections can also produce cellulitis, which is a tender swollen redness on the skin. Oral antibiotics provide an effective treatment.