Wound assessment — tetanus and closure viva

Assessment, irrigation and tetanus. MEAT: mechanism, neurovascular/tendon examination before LA, anatomy, treatment plan. Tap water equals saline — 663 double-blind (3.5 vs 6.4 percent) and 715 multicentre (4 vs 3.3 percent, RR 1.21).^[1][2] Tetanus per the ACIP wound indication with Td-or-Tdap flexibility.

Closure. Contaminated wounds (RR 2.0) often delayed primary/secondary intention; infection rises with age (OR 1.01/year), diabetes (OR 6.7), width (OR 1.05/mm) and foreign body (OR 2.6), while head/neck lowers it (OR 0.28).^[3] Antibiotics if high risk; safety-net infection advice.