Time factor, infection frequency and quantitative microbiology in hand injuries: a prospective study

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.