Dressing wounds

Steri-Strip bandage covering wound on top of foot. Source: Wikimedia  with CC licence

Information presented here is no substitute for proper training. Be prepared!

If you think you might be in an emergency situation, dial 999 or 112. 

For non emergency advice, dial 111.

When to seek medical advice

You should always get medical advice if the injury:

• does not stop bleeding
• is very large or very deep
• has something embedded in it
• is to an artery or on a joint crease
• is red, sore and painful, or has pus coming out (it may be infected)
• is an old wound that looks like it might be infected
• was caused by a bite (all animal and human bites need medical attention)

Most human bites are the result of a "closed fist injury", where one person punches another person in the teeth and cuts their hand. Typical symptoms include small cuts to the hand and red, swollen and painful skin.

If you are not sure how serious your injury is, it is best to get a healthcare professional to check it. If you have a large wound or a deep cut, they will need to examine it carefully to assess how serious it is. They will also clean the wound thoroughly before stitching it up.

For further advice about cuts and wounds, you can visit your nearest walk-in centre or minor injury unit (MIU), or you can call NHS 111.

Tetanus vaccination

It is very important to check that you are up to date with your tetanus jabs if your skin is broken in an injury, or if you are bitten. You will be given a booster jab if your GP thinks you need one.

How to clean a wound

A wound is a break in the skin. A plaster or larger dressing is usually all that is needed to stop a wound bleeding. However, you might need to apply pressure to the area, and if an arm or leg is affected, you should raise it above heart level.

• Before putting on a plaster or other dressing, you will need to clean the wound. Follow the steps below to ensure that it does not become infected:
• Wash and dry your hands thoroughly.
• If you have any cuts on your own hands, you should cover them and wear disposable gloves.
• If treating someone else, tell them what you are doing.
• Make sure that the person is sitting or lying down.
• If the wound has something embedded in it, leave it in place until you seek medical advice (see below).
• Clean the wound under running tap water, saline (a salt water solution) or use an alcohol-free wipe, gauze pad or soft cloth, but do not use antiseptic, because it may damage the skin.
• Soak the gauze or cloth in the saline solution or water, and gently dab or wipe the skin with it.
• Gently pat the area dry using a clean towel or a pad of tissues, but nothing fluffy such as a cotton wool ball, where strands of material can get stuck to the wound.
• Apply a sterile dressing, such as a bandage or plaster.
• If blood soaks through the bandage, leave it in place and another bandage, and continue to apply pressure on the wound.

Applying dressings

Before applying any dressing, you should wash and dry your hands, and wear disposable surgical gloves if you have them. You should also follow the advice outlined below.

• Make sure that you (or the person who is bleeding) are sitting or lying down.
• Tell the person what you are doing as you apply the dressing.
• If the affected area is bleeding, it should stop if you apply pressure and raise the area higher than the heart (if it’s a lower limb, lie down and raise the affected area above the level of the heart).
• Use a dressing that is slightly bigger than the wound you want it to cover.
• Hold the dressing at the edges, keeping your fingers away from the part that's going to cover the wound.
• Place the dressing on top of the wound – don't put it on from the side.
• A little bit of pressure on the affected area should stop it from bleeding again – but make sure you don't restrict the circulation.

Sterile dressing pads attached to bandages 

• Sterile (hygienic) dressing pads come in a protective wrapping. Once they are out of the wrapping, they are no longer sterile. When applying a sterile dressing pad:
• clean and dry the wound and surrounding skin
• hold the bandage on either side of the pad
• lay the pad directly on the wound
• wind the short end once around the limb and the pad
• wind the other end around the limb to cover the whole pad
• tie the ends together over the pad to secure it, and put slight pressure on the wound

Dressings should be replaced on a regular basis.

If the wound is severe, apply the dressing and seek medical advice.

Plasters (adhesive dressings)

• Plasters are made from a piece of gauze and have an adhesive (sticky) backing. They are usually wrapped in single sterile packs. They sometimes come in different shapes and sizes, or you can cut them to size. Some plasters are waterproof. When applying a plaster:
• clean and dry the wound and surrounding skin (see How do I clean a wound? for more information)
• unwrap the plaster and hold it by the protective strips over the backing with the pad side facing down
• peel back the strips, but don't remove them
• place the pad on the wound, pull away the strips, and press the edges of the plaster down

Plasters should be replaced every few hours.

A small number of people are allergic to the adhesive strips – try to find out if this is the case before applying a plaster.

Applying bandages

• Make sure the person is comfortable and tell them what you are doing.
• Make sure you work from the side of the injury and do not have to lean across their body.
• Keep the injured part of the body supported in the position it will be in when the bandage is on.
• Make sure you use the right size bandage – different parts of the body need different widths of bandage.
• If possible, do not cover fingers or toes when bandaging a limb, so that you can easily check the circulation.
• Apply the bandage firmly, but not tightly, and secure the end by folding it over and tying a knot in the end. You can also use a safety pin, adhesive (sticky) tape, or a bandage clip.
• As soon as you have put the bandage on, ask the person if the bandage feels too tight and check the circulation by pressing on a fingernail or a piece of skin until it turns pale. If the colour doesn’t return straight away, the bandage may be too tight, so you should loosen it. Limbs can swell up after an injury, so check the circulation every 10 minutes after you have put the bandage on. 

Applying butterfly stitches

Butterfly stitches, called Steristrips, are narrow adhesive strips that help to close the edges of a small wound and encourage the skin to heal.

They can be applied to "v"-flap cuts on thin skin on the legs of the elderly, and to some cuts on children. They should not be used in areas where the skin moves a lot (for example, joints) or on oily, moist, or hairy areas.

If the wound is shallow, (less than 5cm long), clean and uninfected, and you are sure that there is nothing embedded in it, butterfly strips can be used. Make sure the skin around the wound is also clean and dry. It's not always necessary to use the full length of the strips, and you can cut them to a more appropriate length. Leave about 3mm between each strip.

• Carefully line up the edges of the wound.
• Push them together, and, starting at the middle of the wound, apply the strips to keep the edges closed.
• Place half of the strip on one side of the wound, bring the edges together by gently bringing the other side towards it, and then pass the strip over.
• Place strips alternately above and below the first strip – this helps to match up the edges and keeps the skin tension equal.
• To anchor the rows of strips in place, put two strips across the rows (one on each side of the wound).

A protective dressing is not usually necessary, but the wound must be kept dry until the strips are removed (around three to five days if on the head, or 10-14 days for cuts over the joints). If the strips are difficult to remove, it may help to moisten them with warm water for around 10 minutes.

If the wound does not stop bleeding once the strips have been applied, this is a sign that butterfly stitches are not suitable. You should seek medical advice, as another method of treating the wound may be required.

 *Text sources = NHS with Open Government License