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previous tetanus immunizations but the wound is not a clean, minor laceration,
tetanus toxoid is indicated if the last dose was more than 5 years prior.
In many cases, the tetanus immunization record is unknown. If tetanus status is
unknown or the patient has received less than three doses of tetanus and the
wound is not clean or minor, tetanus toxoid and tetanus immunoglobulin (TIG)
are indicated. Wounds involving massive tissue destruction and contamination
may also require TIG (see Table 110.1 ). Patients with such wounds should be
admitted to the hospital.

Wound Aftercare
Careful discharge instructions regarding wound care, covering the wound, when it
is ok to get the wound wet, and how to dry it are extremely important. A
summary of discharge instructions is provided in Table 110.4 . The family should
be informed about signs of infection. Specifically, they should be told to return
for medical care if the wound develops increasing pain, redness, edema, and/or
wound discharge, or if the child develops a fever. Analgesics such as ibuprofen
and acetaminophen may be given for minor pain, but worsening pain should
always prompt a wound check. The family should also be informed that the
wound was carefully inspected, and there is still a possibility of a retained foreign
body or an undetected injury that may require further treatment.
Parents should be told that no matter how skillful the repair, every laceration
leaves some scar. The appearance of the scar will change during the next several
months, and the scar’s appearance will not be complete for about 6 to 12 months.
Studies have not shown any specific ointments or creams to be helpful in scar
reduction. What has been shown is that less sun exposure will help reduce scar
formation and hyperpigmentation. Therefore, generous application of sunscreen
for at least 6 months is crucial for optimal results during wound healing.