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The variety of foreign bodies which have found their way into the rectum is hardly less remarkable than theingenuity displayed in their removal. A turnip has been delivered PR by the use of obstetric forceps. A stick firmly impacted has been withdrawn by inserting a gimlet into its lower end. A tumbler, mouth downwards, has several times been extracted by filling the interior with a wet plaster ofParis bandage, leaving the end of the bandage extruding, and allowing the plaster to set.


Injuries to the skin, including simple lacerations, abrasions, contusions and foreign bodies, are amongthe commonest problems encountered in generalpractice. To manage these cosmetically importantinjuries well is one of the really basic and enjoyableskills of our profession.

Key facts and check points

  • Keep a well-prepared treatment room with good, sterile instruments and dressings, and an assistantwho facilitates their management.

  • With lacerations, check carefully for nerve damage, tendon damage and arterial damage.

  • In wounds caused by glass, beware of slivers—explore carefully and X-ray (or high-resolutionultrasound) if in doubt.

  • Beware of electrical or thermal wounds becausemarked tissue necrosis can be hidden by slightlyinjured skin.

  • Beware of roller injuries such as car wheels.

  • Beware of pressure gun injuries such as oil andpaint. The consequences can be disastrous.

  • Beware gravel rash wounds, where retainedfragments of dirt and metal can leave a 'dirty’,tattoo-like effect in the healed wound.

  • Avoid suturing the tongue, and animal and humanbites, unless absolutely necessary.

  • Keep diagrams or photographs of wounds in yourmedical records.

  • Have a management plan for medical needle-stickinjuries.


A contusion (bruise or ecchymosis) is the consequenceof injury causing bleeding in subcutaneous or deepertissue while leaving the skin basically intact. It mighttake weeks to resolve, especially if extensive.

A haematoma is a large collection of extravasatedblood that produces an obvious and tender swelling ordeformity. The blood usually clots and becomes firm, warm and red; later (about 10 days) it begins to liquefyand becomes fluctuant.

Principles of management

  • Explanation and reassurance

    RICE (for larger bruises/haematomas) for 48 hours

    R = Rest

    I = Ice (for 20 minutes every 2 waking hours)

    C = Compression (firm elastic bandage)

    E = Elevation (if a limb)

  • Analgesics: paracetamol

  • Avoid needle aspiration (some exceptions)

  • Avoid massage

  • Local heat may be applied after 72 hours

  • Consider possibility of bleeding disorder ifbleeding is out of proportion to the injury

Problematic haematomas

Some haematomas in certain locations can causedeformity and other problems.

Haematoma of nasal septum1

Refer to CHAPTER 48.

Haematoma of the pinna1

When trauma to the pinna causes a haematomabetween the ...

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