How
often do you surf? Everyday? Once a month?
Let’s say you surf for two hours a session,
once a week. After 50 weeks….that’s
100 hours a year. After ten years, you surfed
approximately 1000 hours? According to the
January, 2007 issue of the American Journal
of Sports Medicine you can look forward to
about 13 acute injuries for every 1000 hours
surfed. If you surf one day a week for two
hours on a rock bottom break or in overhead
waves, then you will reach the 13 acute injuries
in about 4 years. If you are lucky enough
to surf 4 days a week for two hours in overhead
waves, then you will reach the 13 acute injuries
in about a year. If this is you, email me
immediately so I can dial in your secret spot.
The point: surf injuries are inevitable. Lacerations,
contusions, sprains/strains, and fractures
are medical problems you should be ready to
quickly conquer in order to return to the
waves.
Nasty
gouge
One
acute injury you might overcome with a little
help is the laceration. A ‘lac’
is a cut. I have had a few from surfing, a
couple of times my fin caught my leg and once
I kicked out and my fin found my head. Talented?
The worst lacs are from loose boards bonking
other surfers, perhaps the reason for more
helmets in the line up. The site of blood
oozing down your buddy’s face is a little
frightening, but easily handled. What to do?
Well, even if the waves are good, any size
laceration deserves a trip to the shore. What
next? Find a clean towel, and hold pressure
directly on the cut. Early on in surgery training
you learn the expression, “All bleeding
stops.” It really does. Hold the towel
firmly on the laceration for five minutes.
The trick here is to apply significant pressure
directly to the wound and not to peek. This
direct pressure should allow the blood’s
coagulation factors to go to work. If the
cut is small to moderate in size then the
bleeding should reduce to a trickle. A large
laceration deserves immediate attention by
the Emergency Department. Here is a trick
for managing the smaller cuts.Physicians discovered
the magic of Cyanoacrylate or crazy glue for
repairing lacerations in the 1970s. Repairing
a small cut on the chin of a four-year old
with sutures is like scrapping with a Tasmanian
Devil. Traditionally, you inject local anesthetic
which feels like a bee sting until the chin
goes numb. Then take another needle and try
to sew the skin edges together. Little groms
are mighty strong when faced with needles.
Most kids require restraint by their parents;
some are placed in a straight jacket or even
given sedation (the kids not the parents).
If the bleeding stopped and the wound is dry,
crazy glue could quickly bring the skin edges
together as good as sutures without the needles.
Physicians were taking a risk by using crazy
glue because of the lack of FDA approval but
many swore by it. Of note, this wound care
technology advanced during the Vietnam War
when a spray version was used to prevent exsanguinations
in soldiers with heavy injuries during the
golden hour transport to medical care
Pain
in the knee
Repairing
a small cut on the chin of a four-year old
with sutures is like scrapping with a Tasmanian
Devil. Traditionally, you inject local anesthetic
which feels like a bee sting until the chin
goes numb. Then take another needle and try
to sew the skin edges together. Little groms
are mighty strong when faced with needles.
Most kids require restraint by their parents;
some are placed in a straight jacket or even
given sedation (the kids not the parents).
Does it work with surfer’s cuts? Absolutely.
Some years went by and the products Dermabond
and Liquid Bandage were ‘crazy glues’
approved by the FDA. Both are fantastic with
children; tell the kiddies a magical potion
will fix the cut without needles and no more
tears. Does it work with surfer’s tears?
Absolutely Bring the edges together of a clean,
dry cut and apply the adhesive. One person
can apply the product and one can push the
skin together. For moderate size cuts, allow
the skin to dry for 5 – 10 second and
then reapply. Keep your hands far away from
the wound; if the adhesive sticks to your
hands during application then you will cause
the wound to open when you pry your hands
off. My patients can shower 24 hours after
Dermabond application but should stay out
of the ocean for a week. And definitely don’t
rub the cut because it will open up.
What can you do if you are ‘trapped’
on Tavarua with a laceration and your buddies
are still surfing? Try crazy glue, it does
work. Be sure to get checked when returning
to civilization, lacerations have a habit
of becoming infected. As a warning for the
super adventurous without medical training,
a memorable patient of mine after a two-week
heroin binge presented with a superinfection
of her left arm requiring amputation along
with chest wall debridement. Definitely seek
medical advice for large wounds.
What happens when a small surf lac is ignored?
Look to the email bag
Dear Dr. Jude,A hole in my wetsuit led to
a cut in my knee. This cut steadily gets wider
& deeper everyday. As i get out of the
water the scab that formed over the day and
night is gone by the end of the morning session.
I have been told these are referred to as
Sea Ulcer. It seems that even keeping covered
and Neosporin healing effects are not enough
to heal or stop the cut from growing. I have
tried to stay out of the water and went 4
days but then overhead waves won out and in
one session basically right back to where...
Is their anything I can so that doesn’t
involve a 2 week prison sentence on dry land?
A small cut that was properly treated with
skin glue could have avoided the ulcer pictured.
Staying out of the water a couple of weeks
is the first step and might be all that is
necessary. The location on the knee could
indicate an infection in the tissue underneath,
which can lead to a 'septic joint'. A septic
joint can cause mobility issues for years.
Treat this wound with caution and see a physician
if it remains after a week on dry land. Also,
diabetics are at a greater risk for underlying
infections and if this is you, seek immediate
evaluation of ulcers like this. Oh yeah, during
dry land prison sentences remember to take
your suit in for a repair.
For more details about Dermabond or Liquid
Bandage, check www.dermabond.com or www.bandaid.com/liquid_bandage.shtml
and keep any adhesive away from your eyes
and mucosal surfaces. Check out the following
article for more in depth reading on Dermabond
application, www.aafp.org/afp/20000301/1383.html
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