Time Factor, Infection Frequency and Quantitative Microbiology in Hand Injuries

Abstract

In a prospective study for 108 surgically treated hand wounds the infection rate was significantly lower in tidy than in untidy injuries (6 and 32%). Infection was significantly more frequent when slough developed than in wounds without slough (54 and 11%). Only seven patients received antibiotic prophylaxis. Quantitative analysis of bacteria in the wound margins was performed in 89 cases. No significant difference in the frequency of infection was found when the cultures yielded greater than 10(5) or less than 10(5) bacteria/gram tissue. Prolongation of the interval between injury and operation (up to 18 hours) was not associated with increased rate of infection. Cases with longer intervals than 18 hours were too few for statistical analysis. The duration of the operation or of tourniquet application did not influence the infection rate. The importance of adequate wound care, gentle technique and staged treatment are discussed, and also the question of prophylactic antibiotic medication.

Early versus Delayed Surgical Treatment in Open Hand Injuries: A Paradigm Revisited

“…The main features of the study population were comparable to other hand injury studies [9,10]. The observed overall infection rate was 14% in this study and thus comparable to the above-reported infection rates (16 and 11%).…”

“…Nylen and Carlsson [10] investigated delaydependent bacterial counts and infection rates in tidy versus untidy hand injuries, but they did not stratify by injury complexity or examine the functional outcome. The investigations of McLain et al [9] were limited to open hand fractures but did not include simple or complex soft tissue injuries, which occur more frequently.…”

Can Open Hand Injuries Wait for Their Surgery in a Tertiary Hospital?

“…Based the current literature, infection rates of open hand injuries are up to 14%. 13,14,18 Comparatively, our study had an infection rate of 1.3%, where the majority of our cases (85.3%) had surgery performed within 72 hours of ED presentation. Infection was also not associated with time to delay to surgery.…”

Wilderness Medical Society Practice Guidelines for Basic Wound Management in the Austere Environment

“…87 Another study found no difference in the frequency of hand wound infections regardless of time of presentation, up to 18 hours. 88 Similarly, another study showed no increase in wound failure when closed before 19 hours after injury. 89 Lammers et al 90 reported increased risk of infection after 10 hours (8 hours for hand wounds).…”