Use of antibiotics after complex open hand injury

A prospective study undertaken to examine bacterial contamination at presentation, frequency and type of antibiotic prescribed, and outcome, in 50 patients presenting with hand injuries of varying severity, is reported. Results of a national survey of trends in antibiotic prescribing for similar wounds in plastic surgery units are also recorded. Preoperative swabs cultured normal flora or no growth. Forty-eight patients received antibiotics with little consistency in the agent used, route of administration, or length of treatment. Clinical wound infection occurred in three crush injuries. No significant difference in the numbers of surgeons using antibiotics for clean and crushed injuries of all types was demonstrated. The state of the wound, rather than the tissue damaged, seemed to dictate antibiotic use. In dirty wounds, however, damage to deep structures appeared to be an indication for antibiotics--significantly fewer respondents treated dirty injuries of the skin alone. The authors believe that antibiotic use in open hand injury is of no proven benefit, and that this aspect of hand surgery requires further investigation.