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Introduction: The post-operative protocol following incision and drainage of hand infections is not completely defined; expert opinions vary regarding the effectiveness of post-operative soaks with povidone-iodine. The purpose of this study was to compare the rates of re-operation following incision and drainage for patients receiving povidone-iodine soaks and those receiving routine daily dressing changes. Secondary goals aimed to define the average length of stay, most common pathogens, and most common etiologies for patients with acute hand infections.

Methods: A single center, prospective, randomized trial was performed evaluating 50 consecutive hand infections treated with incision and drainage. Purulent wounds proximal to the wrist crease were not included. Patient records were followed until 30 days after the time of discharge. Starting post-operative day one, 25 patients received povidone-iodine soaks three times daily, and 25 patients received daily dressing changes with sterile gauze. The decision to return to the operating room was determined by a fellowship trained hand surgeon based on clinical exam and laboratory data.

Results: The average number of operations for hand infections prior to discharge was 1.73 (n=50). Patients receiving povidone soaks averaged 1.7 operations (n=25). Patients receiving daily dressing changes averaged 1.8 operations (n=25). These averages were not statistically different (p=0.54). The average length of stay was 4.2 days, and significant differences were additionally not observed between the groups (p=0.24). The most common etiology of hand infections was direct inoculation secondary to intravenous drug use, and methicillin-resistant Staphylococcus aureus was the most common pathogen.

Conclusion: Povidone-iodine soaks did not affect the frequency of return visits to the operating room when compared to daily dressing changes.

Level of Evidence: Level II therapeutic