Death from tetanus after a pretibial laceration

doi:10.1136/bmj.324.7351.1442

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Oliver C S Cassell (ocassell@hotmail.com), consultant

Department of Plastic and Reconstructive Surgery, Radcliffe Infirmary, Oxford OX2 6HE

Correspondence to: O C S Cassell

Accepted 27 September 2001

It is important to follow the guidelines for treating wounds prone to tetanus

Clinicians should be familiar with Department of Health guidelines for immunoprophylaxis when wounds through which tetanus can be acquired occur.1 I report on a patient in whom tetanus immunoprophylaxis did not follow the guidelines.

Case report

A 76 year old woman fell in her garden and sustained a pretibial laceration. Her wound was cleaned and approximated with Steri-strips (3M; Loughborough) at an emergency department. Her status for tetanus immunisation at the time was recorded as “?no previous tetanus injection,” and a course of antitetanus treatment was started. However, no immunoglobulin was given.

She returned one week later with a necrotic and malodorous wound. She was unwell and complained of diffuse pains. She was admitted for debridement and split skin grafting.

Her condition worsened. Twenty four hours later she developed the signs and symptoms of tetanus, with increasing jaw stiffness, opisthotonos, and generalised limb spasticity. Cultures from the wound produced a …