Camillo T. Müller

Background/Objectives: Posttraumatic infections are common in emergency hand surgery. Amputation is the worst outcome and can occur at admission or during the course of antibiotic treatment and iterative surgical debridement. We wondered if the prolongation of antibiotic treatment beyond the usual indication, and more surgical debridement besides its immediate benefit, could reveal additional preventive effect against amputation during or immediately after therapy. Methods: We investigate 166 risk association (variables) of community-acquired (traumatic) hand infection with overall treatment failure using a specifically designed retrospective single-center cohort between 1 November 2018 and 31 October 2020. Results: Among 600 patients (362 males; 71 (11.8%) with diabetes mellitus), 58 (9.7%) required initially unplanned amputation during the therapeutic ourse. Multivariate Cox regression analysis identified only inherent risks associated with “amputation”: male sex (hazard ratio [HR] 3.12, 95% confidence interval [CI] 1.28–7.69, p = 0.01), age (HR 1.03, 95% CI 1.01–1.04, p = 0.03), diabetes (HR 2.40, 95% CI 1.15–5.01, p = 0.02), whereas no interventional variables such as early flapping or antibiotic-related parameters (early empirical antibiotic use, total duration of antibiotics including its initial parenteral use, and choice of agent) altered outcomes. Conclusions: In severe (traumatic) hand infections among 600 patients, the outcomes were determined by the extent of trauma and underlying comorbidities. The outcomes do not seem to be effectively reduced by more surgery or initial antibiotic treatment.

Background/Objectives: Acute hand infections are common in emergency surgery. Amputation is the ultimate fate when antibiotics and the prior surgical repair fail. Unsurprisingly, clinician tend to exaggerate with the evidence-based indications of antibiotic treatment and flaps. Methods: We investigate 166 risk association of community-acquired (traumatic) hand infection with amputation, overall treatment failure and the necessity for a secondary flap, using a specifically-designed retrospective single-center cohort between March 2018 October 2020 in Germany. Results: Among 600 adult patients (362 males; 71 (11.8%) with diabetes mellitus), 58 (9.7%) required an amputation. Multivariate Cox regression analysis identified only inherent risks associated with "amputation": male sex (odds ratio [OR] 3.12, 95% confidence interval [CI] 1.28-7.69), advanced age (OR 1.03, 95% CI 1.01-1.04), diabetes (OR 2.40, 95% CI 1.15-5.01, whereas all interventional variables such as early flapping or antibiotic-related parameters (early empiric antibiotic use, total duration of antibiotics and of tits parenteral part, choice of agents,) could not alter outcomes. Conclusions: In severe (traumatic) hand infections among adult German patients, the outcomes are determined by the extent of trauma and underlying co-morbidities. The outcomes do not seem to be effectively reduced by exaggerations of the indication of surgical or antibiotic interventions.