Resident Manual of Trauma to the Face, Head and Neck

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 Unknown vaccination history or <3 vaccinations in the tetanus series

Use tetanus-diptheria toxoid (Td) or the diphtheria, tetanus, and pertussis (DTP) vaccine. 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. TIG vaccination is unnecessary for minor wounds, where risk of tetanus infection is extremely low.

Minor, low-risk wounds

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.

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