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y
y
Cost-effective.
y
y
Low reactive potential.
3. Mupirocin (e.g., Bactroban®)
y
y
Provides excellent activity against gram-positive Staph and Strep
species, to include MRSA as well as
Staphylococcus pyogenes.
y
y
Found in one study to have an effect equal to that of oral cephalexin
in treatment of secondarily infected minor wounds.
2
y
y
Poor cost profile.
y
y
Low reactive potential.
C. Tetanus Prophylaxis
Table 9.1 presents recommendations for preventing tetanus in patients
under three different scenarios.
Table 9.1. Recommended Tetanus Prophylaxis under Different Scenarios
Scenarios
Recommended Tetanus Prophylaxis
<7 years of age, or >5 years
since last tetanus vaccination
Use tetanus-diptheria toxoid (Td) or the
diphtheria, tetanus, and pertussis (DTP) vaccine.
Unknown vaccination history
or <3 vaccinations in the
tetanus series
Apply tetanus immune globulin (TIG) 250–500
units intramuscular.
Give Td to these patients and to patients who
have not been vaccinated in more than 10 years.
Minor, low-risk wounds
TIG vaccination is unnecessary for minor wounds,
where risk of tetanus infection is extremely low.
D. Post-Repair Directives
Various strategies to prevent infection and promote wound healing and
cosmesis exist following closure of soft tissue wounds.
1. Moisturization
As moisturization has been shown to improve the rate of wound
re-epithelization, antibiotic ointments or petroleum-based jelly should
be applied until sutures are removed or resorbed. Although definitive
data demonstrating lower infection rates with antibiotic-containing
options are lacking, application of bacitracin- or mupirocin-based
ointments for the first 5–7 days is recommended. Petroleum jelly may
be used thereafter.
2. Daily Debridement
Along incision lines, daily debridement of crust formation with dilute,
half-strength hydrogen peroxide via cotton tip applicator should be
implemented.