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Esmarch exsanguination in acute hand infections: evaluating risk of infection spread
Jacob Zeitlin, BA
1; Sebastian D Arango, BS
1; Jason C. Flynn, B.S.
2; Jon Hammarstedt, MD
3; Tristan B. Weir, M.D.
1; Andrew J. Miller, M.D.
11Philadelphia Hand to Shoulder Center, Philadelphia, PA; 2Sidney Kimmel Medical College, Philadelphia, PA; 3Allegheny Health Network, Pittsburgh, PA
Introduction: When operating on acute hand infections, surgeons often avoid using Esmarch to exsanguinate extremities before tourniquet inflation, due to concerns about bacteremia and systemic infection spread. However, there is minimal evidence to support this dogma. This study aimed to compare infection-related complication rates with and without Esmarch.
Materials & Methods: This retrospective cohort study was conducted from December 2020 to March 2024 at a level 1 trauma center. Patients who underwent surgery for hand and forearm infections within 21 days of symptom onset were included, and those with systemic infection at admission were excluded. Between the two groups, Esmarch and non-Esmarch, Fisher's exact test was used to compare incidences of three infection- related complications: repeat irrigation and debridement (I&D), hematologic spread of infection, and readmission within 30 days.
Results: Between the Esmarch (n=33) and non-Esmarch (n=47) groups, overall complication rates were similar (15.2% vs. 8.5%,
P = 0.477). Specifically, 12% of Esmarch and 6% of non-Esmarch patients required repeat I&D (
P = 0.439). One patient in each group had hematologic spread (
P = 1.000). Readmissions were 9% in the Esmarch group and 2% in the non-Esmarch group (
P = 0.301). At baseline, there were no significant group differences in demographic characteristics, and tourniquet times were comparable (21 vs. 20 minutes,
P = 0.779).
Conclusions: No significant difference in infectious complication rates was found between Esmarch and non-Esmarch groups. Further studies are needed to externally validate these findings. Potential advantages offered by Esmarch (e.g., improved visualization) should be explored in the context of an evidently minimal association with infection-related complications, calling into question its longstanding avoidance based on theoretical yet unsubstantiated risk.
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