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The Role Of Prophylactic Antibiotics In Hand Trauma: A Systematic Review and Meta-Analysis
Jennifer Alicia Klok, MSc, MD; Rosalind Ashton, MD; Kirsty Usher Boyd, MD, FRCSC
Department of Surgery, Division of Plastic Surgery, University of Ottawa, Ottawa, ON, Canada

Purpose: Traumatic hand injuries are common in plastic surgery. However, there is no consensus on the role of prophylactic antibiotics in complex hand injuries. The goal of this systematic review was to evaluate the use of prophylactic antibiotics in hand trauma and determine effect on infection prevention through meta-analysis.

Methods: The databases MEDLINE, CENTRAL, and EMBASE were searched electronically. Studies were eligible if they were randomized controlled trials (RCTs) evaluating antibiotic use in hand trauma. Bite wounds, burns, and simple lacerations were excluded. Full-text selection and data abstraction were carried out by two reviewers independently and in duplicate. A meta-analysis of studies was conducted when possible. Subgroup analysis based on injured structure and wound contamination was also performed.

Results: Nine eligible RCTs were identified. Eight of these studies were included in the meta-analysis. Pooled results for all included hand injuries showed that antibiotics did not have an effect on infection risk (p=0.22). Similarly, antibiotics in open fractures did not reveal benefit when data was combined from four RCTs (p=0.50). However, a single RCT did show a significant increase in infection in open fractures without antibiotics. Additional subgroup analysis for specific hand injuries did not show a difference between intervention and comparison groups.

Conclusions: This is the first systematic review evaluating the use of antibiotics in hand injuries more complex than simple lacerations. Results from most individual studies as well as from pooled data do not support prophylactic antibiotics for the majority of traumatic hand injuries. While proper irrigation and debridement of hand wounds remain the standard of care to protect against infection, the routine use of antibiotics is not evidence based.

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