The role of antibiotics in the management of elective and post-traumatic hand surgery.

The use of prophylactic antibiotics in elective and emergency hand surgery is an unsettled issue. Although their benefit in general surgical cases and certain orthopedic cases is well established, the lower infection rates in elective and emergency hand surgery have made attempts to prove the efficacy of prophylaxis more difficult. Valid arguments can be made for the use of antibiotics in human and animal bites. Prophylactic antibiotic use is efficacious in the following scenarios: (1) soft-tissue reconstructive procedures with large flaps, (2) total elbow or wrist implant arthroplasty, (3) procedures of long duration, and (4) complex open hand trauma with wound contamination and extensive soft-tissue and bony injury. Antibiotic prophylaxis does not appear warranted in clean, elective procedures lasting fewer than 2 hours. The duration of antibiotic use should be as short as possible to minimize complications and the development of bacterial resistance. The selection of a particular antibiotic regimen remains the surgeon's choice, but many inexpensive and relatively safe antibiotic agents are available. Although uncommon, potentially serious hazards exist with the use of antibiotics. Definitive guidelines on the use of antibiotics in hand surgery are not available; hand surgeons should apply basic principles of prophylaxis and be aware of the existing controversies.