WOUND COMPLICATIONS

7. TETANUS

• Tetanus is an important endemic infection in India with an annual incidence of 100 per 1,00,000 population in most cases following a street accident. The signs and symptoms are a manifestation of the effects of the endotoxin of cl.tetani.
• All wounds must be thoroughly cleaned with removal of all organic and inorganic debris
• Immunisation against tetanus is done using:
a) Human Anti tetanus globulin (ATG)
b) Tetanus Toxoid Vaccine
• In fully immunised patients with a booseter dose within the past 5 years, no further immunisation is required. Fully immunized patients but with more than 5 years since last booster only require a booster toxoid dose-0.5ml 1/m at the time of injury. These patients with dirty, heavily contaminated wounds also require a dose - 250-500 IU 1/m of ATG at the time of injury
• Patients with no immunization/incomplete immunisation should receive full course of immunisation. Such patients with contaminated, penetrating or injuries more than 6 hours old should also receive one dose of ATG

8. Wound dehiscence or breakdown occurs most often in postoperative abdominal incisions usually in the first week when the tensile strength is low and especially when tension increases due to abdominal distention or coughing.It may also occur due to already mentioned factors influencing wound healing (Section 4).

Other factors responsible are:
• Obesity
• Corticosteroid therapy
• Abdominal distension (ileus)
• Advanced age

9. SCARS
Most wounds continue to remodel for more than a year.However, some scars are not accpetable.

9.1 Hypertrophic scars are composed of dense fibrous tissue due to excessive collagen synthesis and have
a) Tense swollen appearance
b) Reddish colour
c) Itching - tenderness and hypertrophy
d) No tendency to spread to adjoining tissue
They do not enlarge beyond six months after injury.
Fig 1.8

9.2 KELOIDS
These scars invade adjoining tissue and enlarge even after 6 months. Treatment of these scars is difficult (discussed in chapter 10.
May require local cortisone or radiotherapy to control their spread and other symptoms.

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