USE OF ANTIBIOTICS AFTER COMPLEX OPEN HAND INJURY

A prospective study undertaken to examine bacterial contamination at p resentation, 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 prescri bing for similar wounds in plastic surgery units are also recorded. Pr eoperative swabs cultured normal flora or no growth. Forty-eight patie nts received antibiotics with little consistency in the agent used, ro ute of administration, or length of treatment. Clinical wound infectio n occurred in three crush injuries. No significant difference in the n umbers of surgeons using antibiotics for clean and crushed injuries of all types was demonstrated. The state of the wound, rather than the t issue damaged, seemed to dictate antibiotic use. In dirty wounds, howe ver, damage to deep structures appeared to be an indication for antibi otics - significantly fewer respondents treated dirty injuries of the skin alone. The authors believe that antibiotic use in open hand injur y is of no proven benefit, and that this aspect of hand surgery requir es further investigation.