[Surgical reality and prognostic criteria of severe infections of the hand].
OBJECTIVE
The aim of this study was to evaluate, whether early and radical debridement for hand infections within a single operation followed by at most one second-look revision, is considered as sufficient to heal the infection or not. As one revision followed by at most one second-look revision is not successful for all cases, the value of defined variables on the clinical course and their clinical relevance were evaluated.


METHODS
In this prospective study 50 patients (Mean age: 44; SD: 18 years of age) were included, who underwent surgical treatment in our hospital for severe infection of the hand. The individual course of each patient was documented. Patients, who needed more than two operations to heal the infection (group B) were compared with patients, who underwent one operation followed by at most one second-look revision (group A) under consideration of cause of infection, microbiology, pretreatment, preexistent diseases, and C-reactive protein.


RESULTS
Mean inpatient treatment lasted 19.3 (SD: 19.2) days. Patients underwent 4.4 operations (range: 1-24). For infect healing 22 of the 50 patients (group A) required 1-2 surgical revisions. For 28 patients (group B) more than 2 revisions were necessary. For patients of group B the cause for the infection was more often unknown (p<0.05). Patients who already underwent pretreatment externally showed a significantly increased risk for a prolonged course (p<0.05). A preexistent disease or an increase of CRP had no significant influence on the healing process (p>0.05).


CONCLUSIONS
Even if the concept of early and radical surgical debridement is consistently and adequately realized, healing of hand infection was achieved in less than 50% of the cases with one revision followed by at most one second-look revision. Particularly patients, who already underwent pretreatment externally before evaluation of a hand surgeon seem to be inclined to a prolonged courses of treatment.
Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Moorenstrasse 5, Düsseldorf.
T
T
Lögters
M
M
Hakimi
J
J
Windolf
M
M
Schädel-Höpfner
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis / Q000601:surgery*; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D005385:Fingers / Q000601:surgery; D005500:Follow-Up Studies; D006225:Hand / Q000601:surgery*; D006230:Hand Injuries / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D012086:Reoperation; D013524:Surgical Flaps; D014946:Wound Infection / Q000175:diagnosis / Q000601:surgery; D055815:Young Adult
D000900:Anti-Bacterial Agents