Tetanus: A Serious Threat Behind Neglected Wounds from a Surgeon's Perspective

Open wounds are a risk that is often underestimated, even though in certain cases, it can lead to serious infections such as tetanus. Tetanus is a bacterial infection caused by Clostridium tetani, which can cause severe muscle spasms and is potentially fatal if not treated immediately. For surgeons, tetanus infection is a serious threat, especially for patients who receive treatment late or who do not realise the importance of prevention and early treatment of open wounds.

1. What is Tetanus? 

Tetanus is an infectious disease that attacks the central nervous system due to toxins produced by Clostridium tetani. These bacteria are generally found in soil, dust, and animal faeces, which then enter the body through open wounds. Wounds that are at high risk for tetanus infection are deep puncture wounds, burns, animal bites, and wounds contaminated with soil or dirt. The bacterium Clostridium tetani produces the toxin tetanospasmin, which attacks the nerves and causes muscles to stiffen and spasm. If this infection is not treated immediately, it can result in serious complications such as respiratory problems and even death. From the surgeon's perspective, understanding wound characteristics and tetanus risk is important, especially when treating patients with open wounds that may have become infected.

2. Symptoms and Diagnosis of Tetanus 

Symptoms of tetanus usually appear within 3-21 days after the bacteria enter the body through a wound. Initial symptoms include muscle stiffness, especially in the jaw and neck area (trismus), as well as spasms that spread throughout the body. In more severe cases, patients experience difficulty breathing and swallowing, as well as uncontrollable muscle spasms. In the diagnosis process, surgeons often consider the patient's injury history and condition. If the patient has a deep wound that is left untreated, the doctor will be alert to the possibility of tetanus infection, especially if the patient has never received immunisation or experienced a delay in treating the wound.

3. The Role of the Surgeon in Preventing and Treating Tetanus 

Surgeons play an important role in tetanus prevention, especially through prophylaxis and patient education. For high-risk patients, such as those with puncture wounds or dirty wounds, surgeons generally recommend tetanus immunisation, especially if the patient's vaccination history is unclear or incomplete. In Indonesia, tetanus vaccination (tetanus toxoid) has become part of the national immunisation program to prevent this disease.

Proper wound cleaning and immediate treatment are the first steps in preventing tetanus infection. For surgeons, it is important to ensure that each wound treated is cleaned and sutured using sterile techniques to minimise the risk of infection. Apart from that, the doctor also gives antibiotics according to the condition of the wound to suppress bacterial growth.

4. Tetanus Treatment in the Operating Room 

If tetanus infection has occurred, the patient may require intensive care, including mechanical ventilation if breathing is compromised. In the operating room, the surgeon may perform wound debridement to remove dead tissue and reduce the amount of bacteria in the wound. This treatment must be done carefully so as not to worsen the patient's condition. Sedatives and muscle relaxants are also often used to relieve painful muscle spasms.

In cases of advanced tetanus, treatment in the ICU is often necessary due to the high risk of complications. Surgery is usually only performed in a very emergency situation to control infection. For surgeons, ensuring appropriate treatment at an early stage is a crucial step in preventing this condition from developing into a more serious condition.

5. Conclusion

From a surgeon's perspective, tetanus is a real threat that can occur to anyone with an open wound that does not receive proper treatment. Education to the public about the importance of preventing tetanus and good wound care needs to continue to be conveyed to reduce infection rates. For those with wounds, it is important to clean the wound immediately, avoid contamination, and seek medical care if the wound looks severe or dirty. In addition, surgeons strongly recommend that the public complete tetanus vaccination as an effective preventive measure. 

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Referensce:

1. Badan Penelitian dan Pengembangan Kesehatan. (2019). Laporan Nasional Riskesdas 2018. Kementerian Kesehatan RI.

2. Kementerian Kesehatan Republik Indonesia. (2023). Pedoman Imunisasi di Indonesia.