Juon Bettina H, Iseli Michelle, Kreutziger Janett, Constantinescu Mihai A, Vögelin Esther
Department of Plastic, Reconstructive and Hand Surgery, University Hospital Berne and University of Berne , Switzerland.
J Plast Surg Hand Surg. 2014 Oct;48(5):330-3. doi: 10.3109/2000656X.2014.886581. Epub 2014 Feb 17.
The 6-hour paradigm for surgical treatment of open injuries should be re-evaluated in the era of systematic use of antiseptic solutions and systemic antibiotics. The current study investigates prospectively the impact of timing of surgery on the outcome of open hand injuries. The prospective evaluation included adult patients presenting with open hand injuries between 1 September 2009 and 30 June 2010 to the emergency department of the University Hospital of Berne, Switzerland. Multiple trauma, bilateral hand injuries, bite injuries, and infections were excluded. All patients underwent a standardised treatment protocol with antiseptic solution, sterile dressing, antibiotic prophylaxis, and surgical treatment upon admission. Demographic data, injury details, and delay from trauma to therapy were recorded. Microbiology was gained at surgery. Outcome measurements included infections, complications, pain, and function (clinically, DASH, Mayo score). From 116 patients (mean age 43 years) six patients suffered an infection (5.2%). The observed infections were statistically not associated with delay to surgery, treatment protocol, or to injury complexity. Neither complications, pain, nor functional outcome were statistically associated with delay to surgery, wound disinfection, or administration of antibiotics. In conclusion, early or late timing of surgical treatment of open hand injuries did not show any impact on outcome (infections, complications, pain, function) in this prospective single-centre patient evaluation.
在系统性使用抗菌溶液和全身性抗生素的时代，应重新评估开放性损伤手术治疗的6小时范式。本研究前瞻性地调查了手术时机对开放性手部损伤结局的影响。前瞻性评估纳入了2009年9月1日至2010年6月30日期间到瑞士伯尔尼大学医院急诊科就诊的成年开放性手部损伤患者。排除多发伤、双侧手部损伤、咬伤和感染患者。所有患者入院后均接受标准化治疗方案，包括抗菌溶液、无菌敷料、抗生素预防和手术治疗。记录人口统计学数据、损伤细节以及从受伤到治疗的延迟时间。手术时获取微生物学样本。结局指标包括感染、并发症、疼痛和功能（临床评估、DASH评分、梅奥评分）。116例患者（平均年龄43岁）中有6例发生感染（5.2%）。观察到的感染在统计学上与手术延迟、治疗方案或损伤复杂性无关。并发症、疼痛或功能结局在统计学上均与手术延迟、伤口消毒或抗生素使用无关。总之，在这项前瞻性单中心患者评估中，开放性手部损伤手术治疗的早晚时机对结局（感染、并发症、疼痛、功能）均无影响。
