Efficacy of perioperative cefamandole with postoperative cephalexin in the primary outpatient treatment of open wounds of the hand.

Eighty-seven patients participated in a prospective, double-blind, clinical study to determine the efficacy of preventive antibiotics in the management of common open traumatic hand wounds ranging in severity from single nail bed injuries with open fractures to moderately contaminated wounds involving tendon, bone, joint, and neurovascular structures. Under current medical practice, these wounds would be treated with antibiotics. Thirty-nine patients received intravenous cefamandole and oral cephalexin and 48 received intravenously and orally administered placebo. With an overall infection rate of 1.1%, there were no infections in the antibiotics group and only one (2.1%) infection in the placebo group. Aerobic cultures from 97 similar wounds were 53.6% positive predebridement and 50.5% positive postdebridement. There was no significant difference in rates of infection or imperfect wound healing between the two groups. The preventive antibiotics administered were not necessary in treating these wounds when accompanied by debridement, irrigation, and rapid primary repair in an operating room environment.