The role of prophylactic antibiotics in zone II and zone V acute flexor tendon injury

Abstract

Background: In the literature, there is no universal consensus on the role of antibiotic prophylaxis in patients presenting with simple hand lacerations that has no macroscopic wound contamination. Our study sought to establish the necessity of prolonged pre-operative antibiotic prophylaxis in patients presenting with zone II and zone V acute flexor tendon injuries (FTI) at Chris Hani Baragwanath Academic Hospital (CHBAH). Methods: This was a prospective study of 116 patients who presented with zone II and zone V acute FTI. The study period was between 01 November 2020 and 31 August 2021. Patients were randomised into a group receiving a single dose of prophylactic antibiotic in casualty and another group receiving a single antibiotic dose plus a continuous 8 hourly dose until the day of surgery. Each group was subdivided into occupational and non-occupational injuries. Their post-operative wound outcomes were documented 10 ‒ 14 days after surgery. The wound outcome was reported as no infection, superficial infection (treated with wound dressings), and deep infection (requiring surgical debridement). Results: There was 0.9% rate of deep post-operative wound infections, which was a single zone V acute FTI case in a single dose prophylactic antibiotic group. There was a 7.8% superficial post-operative wound infection rate, which was mainly zone II acute FTI in both antibiotic groups. There was a strong association between zone II acute FTI and post-operative wound infection (p < 0.05). There was no association between (antibiotic dosage or place of injury) with post-operative wound infection (p > 0.05). Conclusion: There is no benefit in prescribing prolonged pre-operative antibiotic in patients with acute, simple lacerations to zone II and zone V FTI if there is no macroscopic wound contamination.