SU17.7 | Soft Tissue Injury Assessment and Management — Summary & Reflection

KEY TAKEAWAYS

A soft tissue injury affects skin, subcutaneous tissue, muscle, tendon, ligament, nerve or vessel, and the danger usually lies in the structures deep to the visible wound. Classify injuries as closed (contusion/bruise, haematoma, sprain of a ligament, strain of muscle/tendon, crush) or open, distinguishing open wounds by mechanism and edges: abrasion (superficial graze), incised (sharp object, clean apposed edges, no tissue bridges), laceration (blunt force, irregular ragged edges, tissue bridges), puncture/penetrating (deep, carries contamination), avulsion, degloving and bite (contaminated puncture + crush). Assess the history (mechanism, contamination, time, tetanus status), the wound itself, and — essentially — the distal circulation, nerves and tendons; classify contamination. Investigations are targeted: X-ray for foreign body/fracture, exploration for suspected deep injury. Management: control bleeding and pain, clean and debride (excise devitalised tissue), then choose primary closure (clean, recent) versus delayed primary/secondary closure (contaminated, old, tissue loss). Always assess tetanus prophylaxis (tetanus-prone wound + immunisation status → toxoid ± human tetanus immunoglobulin) and give antibiotics for contaminated/bite/deep wounds. Closed injuries are treated with RICE and analgesia.

REFLECT

Think of the last wound you saw cleaned and stitched — in casualty, a clinic, or at home. Did the person managing it examine the nerves, tendons and circulation beyond the wound, or just the skin defect? Be honest about how tempting it is to close a wound quickly and move on. Now think about tetanus: could you confidently decide, for any given wound, whether it is tetanus-prone and what prophylaxis the patient needs based on their immunisation history — and would you remember to ask? Consider also the closure decision: would you have the discipline to leave a contaminated wound open for delayed closure rather than suturing it tight? Reflect on one habit you will build — perhaps ending every wound assessment with the tetanus question, or always testing the tendons and nerves distal to a cut — so that your routine wound care never misses the injury or the infection hiding beneath the surface.