How to Treat a Skin Flap or Abrasion During First Aid

A skin flap is a tear of the skin away from the body which leaves one side of the skin still attached. An avulsion is when the skin, and often the tissue below, is entirely removed. Both require special treatment in the wilderness, and if the wound is more than 1 inch in diameter, a skin graft may be required.

Things You'll Need

• Mild Soap Such As Dishwashing Liquid
• Disinfected water
• Rubber Or Latex Gloves
• Povidone-iodine
• Clear palstic bottle
• Tweezers
• Irrigation Syringe
• Bandages
• Tape

Instructions

Preparation

1. Scrub hands thoroughly with soap and disinfected water.

2. Put on latex gloves to prevent the spread of infectious disease.

3. Evaluate and treat the injured person for shock. See "How to Evaluate for Shock" and "How to Treat for Shock."

4. Prepare a disinfectant solution of 1 oz. povidone-iodine and 1 liter disinfected water. See "How to Disinfect Water." Set the disinfectant solution aside for about five minutes.

Cleaning the Wound

1. Scrub the area around the wound using a nailbrush and disinfectant solution. Scrubbing may be painful to the injured person, but it is important that all debris surrounding the wound is removed.

2. Sterilize two pairs of tweezers using the disinfectant solution.

3. If the skin is still attached, pull the flap back using one pair of sterilized tweezers.

4. Remove all large pieces of dirt, debris, dead skin and flakes of clotted blood from the wound using the second pair of sterilized tweezers.

5. Draw the disinfectant solution into an irrigation syringe.

6. Hold the syringe perpendicular to the wound, about 2 to 3 inches above it. Angle the syringe and tilt the wound so that the solution will hit the wound and drain away from the opening.

7. Press down on the plunger to emit a forceful stream of solution. Repeat the irrigation, using 1/2 to 1 liter of solution. You may need to use more if the wound is especially dirty. Make sure the flap of skin is also rinsed thoroughly.

8. Rinse the wound and skin flap liberally with disinfected water, because the disinfectant solution may cause irritation to the skin if left on.

9. Recheck the wound for bleeding, because blood clots may have been dislodged. You may have to apply pressure to stop bleeding. See "How to Stop Mild Bleeding During First Aid."

10. Check the clothing and area around the injured person to make sure his or her skin won't be exposed to disinfectant solution for a prolonged period of time, which may cause burning.

Dressing and Bandaging the Wound

1. If the skin has been removed entirely, dress and bandage the wound as you would an abrasion. See "How to Bandage a Wound During First Aid."

2. If a flap of skin is still attached, use tweezers to reposition the skin over the wound.

3. Place closure strips or small strips of tape along the edges to hold the skin in place - this flap will serve as a skin graft. Space strips so that there are enough openings between them to allow the wound to drain if it becomes infected.

4. Dress and bandage the wound with a bulky dressing. See "How to Bandage a Wound During First Aid."

5. Immobilize the limb to prevent movement of the skin flap. See eHows on splinting.

Continued Care and Evacuation

1. Monitor the wound for infection. See "How to Evaluate a Wound for Infection."

2. Evacuate and seek medical help immediately.

Tips & Warnings

• You will need to have at least 1 liter of disinfectant solution on hand for this procedure.

• Use a clear plastic bottle with measurements on the side, such as a Nalgene bottle, for easy measurement when mixing the disinfectant solution. These bottles include measurements in milliliters and ounces.

• If povidone-iodine is not available, use disinfected water to cleanse the wound.

• Irrigation syringes are also called pressure irrigators. If an irrigation syringe is not available, improvise by puncturing a plastic bag with a small hole, drilling or burning a hole into the top of a water bottle, or using a sports bottle with a squirting top. The idea here is to create a high-pressure flow of water that will remove debris without damaging the tissue.

• Infectious diseases such as AIDS and hepatitis are transmitted via the exchange of bodily fluids. Protect yourself by wearing latex gloves. Wear goggles or glasses to protect against spurting blood or fluids. Wear a surgical mask to prevent the spread of other diseases. If you don't have gloves, a surgical mask and goggles, improvise by placing your hand in a plastic bag, wearing sunglasses and covering your mouth with a bandanna.

• Do not use alcohol, iodine or mercurial solutions to cleanse a wound, because these can damage the tissue.

• Begin antibiotic therapy immediately if in a remote area where medical help is more than 24 hours away. High doses of antibiotics should be given for at least five days. If you anticipate being in a remote area, consult a physician before you leave about bringing a broad-spectrum antibiotic with you. Make sure you bring all the instructions for usage and information about complications of the antibiotic with you into the backcountry.

• This information is not intended as a substitute for professional medical advice or treatment.

Resources

• Read this Article in Spanish