previous tetanus immunizations but the wound is not a clean, minor laceration, tetanus toxoid is indicated if the last dose was more than 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 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 months is crucial for optimal results during wound healing