Hand infections often require multiple surgical washouts and debridements, and are frequently in hospital for several days on intravenous antibiotics . There are currently two schools of thought in management of hand infections with regards to closure. Common practice amongst Orthopaedic surgeons is to close fight bites and infective flexor tenosynovitis wounds following washout, just as in other larger joints that are infected. On the other hand, the well-respected textbook, Green’s, suggest that these wounds should be left open or with a drain left in, to heal by secondary intention. The literature that we found supporting leaving wounds open were all citing papers from the 1980s and 1990s to back up their reasoning. There is minimal current literature reviewing either option, and no comparative studies that we could find.
We wanted to revisit this issue in order to determine which option results in fewer operations and shorter stays in hospital. We did this by auditing the cases of adult MCPJ infected wounds and flexor sheath infections managed within our department of Plastic and Hand Surgery at Middlemore Hospital in the years 2012-2015, to see which (if either) method results in better results for the patient, in terms of numbers of washouts required and length of stay.
Our hypothesis is that there will be no difference in outcomes whether the wounds are closed or left open. Early results however, suggest that closing these wounds may lead to less numbers of operations, and that it is actually the visible presence of pus in these hands that determines length of stay.