Welcome back to Mangled Mondays, where every Monday we talk about another facet of maiming, mangling, mauling, and mistreating your main characters — and all of their friends.
Today we’ll be talking about Lacerations, Incisions, Scrapes and Bruises. For the rest of the Mangled Mondays series, [click here].
Lacerations, Incisions, Scrapes, and Bruises
A great many of the minor injuries our characters suffer fall into this category. A character might cut their leg climbing over a chain link fence or cut their arm open on a broken bottle after taking a spill in the gutter.
First, let’s do some quick differentiation of terms.
Lacerations and Incisions
A laceration is a cut. Some textbooks describe this as having jagged or uneven edges, while others do not.
An incision is also a cut. This is differentiated from a laceration by the edges being smooth and made by a very sharp object such as a scalpel.
Most of the time, lacerations are unintentional, while incisions are made with a purpose in mind.
Both lacerations and incisions are good candidates for healing well, but either may leave a scar, depending on how they are closed, whether the overlying scab is picked at or scraped, and whether the wound reopens. Cuts over joints tend to have longer healing times because the skin is constantly moving and therefore under tension.
Some cuts require formal wound closure, while others don’t. We’ll get to this in the next chapter.
Contusion is a fancy word for a bruise. It’s injury to an area without a break in the skin. (The discoloration from a contusion is also known as ecchymosis, but most medical staff would simply say bruise and move on.) Contusions are caused by damage to minor blood vessels called capillaries, which burst.The blood pools under the skin, causing the familiar discoloration.
Bruises may start off as small red spots of irritation, then blossom blue-black within 24 hours. As they fade, they tend to turn yellow-green. This is due to enzymes breaking down the “loose” blood under the skin.
It was once theorized that the age of a bruise could be guessed by its color, but this doesn’t hold up to science.
A hematoma is a pooling of blood under the skin. It’s like a bruise went 3-D: leaked blood forms a “goose egg” under the skin. Hematomas take longer than bruises to dissipate, up to and including months, but do eventually go down by themselves.
Hematomas are usually treated with cold packs for the first two days, which help to shrink the blood vessels and thus reduce the blood pooling. After two days, heat packs are used to dilate blood vessels and help the blood reabsorb into the tissue.
An abrasion is a five-dollar word for a scrape. (Are doctor’s appointments $5 anymore? I really need to keep up on pricing…) Abrasions are prone to scarring, because large areas of skin have been ripped up, and each individual area of scarring tends to run into the next.
Because the damage from an abrasion tends to be superficial but spread out, and the wound edges tend to be rough, abrasions form large, often unified scabs.
Scabs can be treated simply by protecting them with gauze and allowing them to heal. Topical antibiotics might be used. They can become extremely itchy, which can disturb sleep and impair focus. A scab is a natural sort of bandage to protect the underlying tissue as it heals.
Tetanus vaccines are important for characters suffering any injury that punctures the skin, whether it’s from a rusted metal nail or a clean fragment of plastic. Tetanus is caused by a bacterium, C. tetani, which is present in soil, manure, and other places where nature comes into contact with humanity.
The danger of tetanus is not in what punctures the skin, it’s in the type of wound. Because it’s difficult to clean the deep portions of a puncture wound, it’s extremely easy for pockets of infection, known as abscesses, to form in the well of the wound. Tetanus absolutely loves puncture wounds.
Guidelines vary, but characters will need a tetanus vaccine or booster every 5 or 10 years, depending on their doctor’s guidelines. Because there’s little harm to vaccination other than stiffness and pain in the injection site, characters are likely to get or at least be offered tetanus vaccines for any form of penetrating trauma. If it’s been less than 5 years since their last booster, they’ll not be offered one; the 5-10 year mark may or may not get a tetanus booster, and 10 or more years since last vaccination will require a booster.
The vaccine itself is known as Td, which is a combination vaccine that prevents tetanus and diphtheria. (Characters who have never had one may be offered a TdaP, which prevents tetanus, diptheria, and pertussis, also known as whooping cough.)
xoxo, Aunt Scripty
This post is an excerpt from Blood on the Page Volume One: A Writer’s Compendium of Injuries. The book details thirty-one injuries with which to maim, mangle, and maul your characters, as well as nine indispensable articles of Wound Wisdom covering everything from burn stages to suture selection.