Initial Debridement of Dorsal Hand Abscesses in the Operating Room Does Not Improve Outcomes

Repeat Irrigation and Debridement of Upper Extremity Infections: Do Repeat Cultures Change Antibiotic Treatment Regimens?

BACKGROUND

Organism identification and their antibiotic sensitivity profile are critical for the successful treatment of upper extremity infections. Although many infections resolve with antibiotics alone, some require 1 or more surgical procedures in which culture data are obtained. The purpose of this study was to determine whether repeat cultures taken at subsequent irrigation and debridement of upper extremity infections changed antibiotic treatment.

METHODS

A retrospective review was performed using International Classification of Diseases, Ninth Revision codes to identify all adult patients with an upper extremity infection treated with 2 irrigation and debridement procedures with 2 separate culture data sets over a period of 5 years. Culture organisms and antibiotic sensitivity profiles were compared from each procedure, and changes in antibiotic treatment based on repeat culture information were identified.

RESULTS

In all, 183 patients who underwent 2 irrigation and debridement procedures with repeat culture data were identified. Organisms identified with repeat culture were the same or there was no growth in 153 patients and were different in 30 patients. The antibiotic treatment did not require a change in 170 (92.9%) of 183 patients. Of the 30 patients with different repeat cultures, antibiotic treatment changed in only 13 patients (43.3%). Patients who had a change in antibiotic treatment were more likely to have hepatitis C (P = .005).

CONCLUSIONS

Repeat culture data changed antibiotic treatment in only 7.1% of patients from our cohort. Patients with hepatitis C were more likely to require a change in antibiotic management after obtaining repeat cultures.

Ten Questions About Wide Awake Local Anaesthesia No Tourniquet (WALANT) Surgery

The aim of this review article is to provide many important tips and tricks for surgeons to start Wide Awake Local Anaesthesia No Tourniquet (WALANT) hand surgery in their practice. The massive cost reduction of this disruptive new approach will enable them to increase access to hand surgery for their patients who cannot afford unnecessary sedation or unnecessary sterility of the expensive main operating room environment. Evidence-based sterility will permit surgeons to move a lot of their surgery out of the main operating room to minor procedure rooms without a significant increase in infection rates. Important pointers on how to inject minimally painful local anaesthesia will have patients thinking the surgeon injector is a bit of a magician. WALANT enables surgeons to improve the outcomes of many hand surgery procedures. Level of Evidence: Level V (Therapeutic).