Esmarch Exsanguination in Acute Hand Infections: Evaluating Risk of Infection Spread

Background: This study aimed to evaluate the infection-related complication rates associated with the use of Esmarch exsanguination compared with gravitational exsanguination in patients undergoing surgery for acute hand and forearm infections. Patients and Methods: A retrospective cohort study was conducted from December 2020 to March 2024 at a level 1 trauma center. Adult patients with acute hand or forearm infections who underwent irrigation and debridement (I&D) within 21 days of symptom onset were included. Patients with systemic infection at admission were excluded. The incidence of infection-related complications, including repeat I&D, hematological spread of infection, and 30-day readmission, was compared between those who underwent Esmarch exsanguination and those who did not, using Fisher exact test. Results: The study included 80 patients, 33 in the Esmarch group and 47 in the non-Esmarch group. The overall complication rate was 15.2% in the Esmarch group compared with 8.5% in the non-Esmarch group. Repeat I&D was required in 12.1% of Esmarch patients versus 6.4% of non-Esmarch patients. Hematological spread occurred in one patient in each group, and readmissions were 9.1% in the Esmarch group compared with 2.1% in the non-Esmarch group. There was no statistically significant difference in the rates of infectious complications between the Esmarch and non-Esmarch groups. Conclusions: This study challenges the longstanding avoidance of Esmarch exsanguination in the context of acute hand infections, suggesting that its use does not significantly increase the risk of infection-related complications. These findings suggest that surgeons may consider the use of Esmarch exsanguination in hand surgery without a significant increase in infection-related risks, potentially improving surgical visualization and outcomes. Further studies are needed to confirm these results.