<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 23-year-old man comes to the emergency department with an open wound on his right hand. He states that he got into a bar fight about an hour ago. He appears heavily intoxicated and does not remember the whole situation, but he does recall lying on the ground in front of the bar after the fight. He does not recall any history of injuries but does remember a tetanus shot he received 6 years ago. His temperature is 37C 98.6F, pulse is 77min, and blood pressure is 13278 mm Hg. Examination shows a soft, nontender abdomen. His joints have no bony deformities and display full range of motion. There is a 4-cm 1.6-in lesion on his hand with the skin attached only on the ulnar side. The wound, which appears to be partly covered with soil and dirt, is irrigated and debrided by the hospital staff. Minimal erythema and no purulence is observed in the area surrounding the wound. What is the most appropriate next step in management?? A: Apposition of wound edges under tension rifampin, B: Surgical treatment with skin graft tetanus vaccine, C: Tension-free apposition of wound edges sterile dressing, D: Application of moist sterile dressing tetanus vaccine, E: Surgical treatment with skin flap ciprofloxacin,  <response>: This is a patient with an open wound on his hand that appears to be contaminated with dirt and soil. The key steps in managing this wound are:1. Assess tetanus immunity status and give tetanus vaccine if needed. The patient had a tetanus shot 6 years ago, so he likely needs a tetanus booster. 2. Irrigate and debride the wound to remove debris and prevent infection. This has already been done. 3. Assess whether primary closureapposition of the wound edges is possible without tension. If so, this allows healing by primary intention which is fastest. If not, a skin graft or flap may be needed.4. Apply a sterile dressing andor antibiotic ointment and monitor for signs of infection. Systemic antibiotics are not routinely needed.5. Provide pain control as needed.D: Application of moist sterile dressing tetanus vaccine 