Nadine Hollevoet
Postoperative infections
Postoperative infection risk is higher in patients with a compromised immune system and when blood perfusion of the tissues is inadequate. The latter is the case in the presence of foreign bodies (prostheses, pins, plates, etc.), edema, hematoma and devitalized tissues (dead skin margins, tendon grafts, etc.).A defect in the skin barrier and prolonged operation time also decreaseresistance against infection.Poor patient compliance is another risk factor.
Fortunately, infections following elective hand surgery are uncommon. In retrospective studies with large numbers of frequently performed soft tissue procedures,general infection rateswereless than 1%.In prospective studiesincluding operations on soft tissues and bone, infection rates were higher (up to 10%).This difference may be explained by underestimation of infection rates in retrospective studies. Reported infection rates also may be influenced by the number of cases and the type of surgical procedures included in the studies. Generally lower percentages of infection are found in larger studies. Infection rates of some frequently performed procedures in hand surgery have been published. They ranged between 0.33% and 0.47% following carpal tunnel release, between 2% and 5%following surgery for trigger finger, between 2% and 6% following surgery for de Quervain’s tenosynovitis and between 1 % and 9.5% following surgery for Dupuytren’s contracture. Infection rates were less than 1% following implantation of silicone spacers for PIP and MCP joint arthritis.
Surgery for distal radius fracture is also frequently performed. Reported infection rates following K-wire or external fixation were as high as 21%. When K-wires were buried deep to the skin, infection rates decreased. Infection rates following plate fixation ranged between 0% and 5%.
Differences in infection rates may also be explained by the difficulty to diagnose infection following hand surgery. Wound dehiscence, granuloma and pus clearly indicate infection, but this may be less obvious in wounds with only symptoms of tenderness, redness and swelling. The reported infections also differ in severity. Some cases could be treated non-operatively, othersrequired additional surgery and some infections resulted in a permanent disability.
Most frequently Staphyloccus aureus is grown after surgical site infections of the hand. Gram negative organisms are less common and more found in patients with a compromised immune system. There is evidence for prophylactic use of antibiotics in operations that last more than two hours, in complex reconstructive hand surgery and in dirty wounds (including animal and human bites). Some recommend prophylactic antibiotics also in patients with heart valves, existing total joint arthroplasties, diabetes, rheumatoid arthritis,chronic steroid use and in procedures involving surgery with implants, bone resection and articular surgery.