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Laceration care and tetanus prophylaxis
In wound care, first check nerves, tendons and vessels, clean and irrigate thoroughly, decide on closure by time, site and contamination, and match tetanus prophylaxis to the type of wound and the number of vaccine doses.
Why it matters in the exam
Questions on this topic mainly test the tetanus prophylaxis table: a clean minor wound — vaccine (Td or Tdap) only if the patient had fewer than three doses, does not know, or 10 years have passed since the last dose; a dirty or major wound — vaccine if 5 years have passed, and in addition tetanus immunoglobulin (TIG) 250 units IM if fewer than three doses or unknown.
Closure decisions are also tested: most lacerations are closed primarily within 6–12 hours, on the face and scalp up to 24 hours, while bite wounds of the hand, heavily contaminated wounds and puncture wounds are not closed. Tissue adhesive suits small low-tension lacerations. Irrigation with running tap water is as effective as saline; what matters is the volume and pressure of irrigation.
Practical details are also asked: lidocaine with adrenaline is safe even in fingers; the maximum lidocaine dose is about 4.5 mg/kg without adrenaline and about 7 mg/kg with adrenaline. When a glass foreign body is suspected take an X-ray, and for wood ultrasound is better. Prophylactic antibiotics are not routine, except for bites (mainly cat and hand bites), heavily contaminated wounds and immunosuppressed patients. Suture removal: face 3–5 days, scalp 7–10 days, trunk and limbs 7–14 days.
Key points
- Neurovascular and tendon examination before anaesthesia.
- High-volume irrigation is the most important step in preventing infection.
- Closure within 6–12 hours, face up to 24 hours; hand bites are not closed.
- Tetanus: clean wound — 10 years; dirty wound — 5 years; TIG if fewer than three doses or unknown.
- Antibiotics only for bites, heavy contamination or immunosuppression.
Summary table
| Situation | Clean minor wound | Dirty or major wound | Note |
|---|---|---|---|
| Fewer than three doses or unknown | Td or Tdap | Td or Tdap plus TIG 250 units | TIG at a separate site |
| Three or more doses, last dose under 5 years ago | Not needed | Not needed | — |
| Three or more doses, 5–10 years | Not needed | Td or Tdap | Dirty wound: soil, faeces, saliva, puncture, crush |
| Three or more doses, more than 10 years | Td or Tdap | Td or Tdap | — |
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Sources
- CDC/ACIP, Tetanus prophylaxis in wound management, 2018–2020 recommendations — Guide to tetanus prophylaxis in routine wound management
- Israel Ministry of Health, Immunisation guidelines (חוזר חיסונים), current edition — Tetanus prophylaxis after injury
- Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care, 7th edition (2019) — Wound preparation and closure
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.