gms | German Medical Science

Objectives/Interrogation: In hand surgery, efficient and effective wound management is important, because rapid wound healing results in fast remobilization of the hand, which is significant for effective rehabilitation of the hand function. Factors that can influence wound healing are postoperative wound infections and ineffective immobilization of the hand. In pediatric hand surgery, creating a safe healing environment is even more challenging, because children are more active and therefore the dressing is easily damaged. To avoid pain and stress of the child and parents during wound care and to optimize the postoperative care in congenital hand surgery, we changed the wound management at our institution to a regime where the post-operative dressing stays six weeks in place before removing. We hypothesized that frequent dressing changes are unnecessary and wound inspections after two or three weeks will not prevent wound infections.

Methods: Patients between the age of 0 and 18 years old that received elective hand surgery for their congenital hand malformation were enrolled in this retrospective study. Patients that received desyndactylysation, correction osteotomy, pollicisation, opposition plasty, ray amputation, or chondrodesis/arthrodesis surgery, or a combination of these, were included. The total amount of adverse events and post-operative hospital visits between the dressing regimes were compared with the use of a Chi-square test or Fisher's exact test.

Results and Conclusions: A total of 551 hands were included with 272 hands for the long term and 279 hands in the short term group. Significantly more hand infections were reported in the short term group (42 vs 1) treated with antibiotics. Problems with the dressing were comparable for both (40 versus 43). The same amount of unplanned hospital visits were reported (12.3% vs 12.7%).

In our opinion, frequent dressing changes in elective congenital hand surgery is often unnecessary and asks a lot of effort from children and their parents. Furthermore, infection might be overdiagnoses with an increase in the prescription of antibiotics. Subgroup analyses of patients with syndactyly and Apert syndrome, showed more infections in the short term group. Considering our results, it seems that when using a FTG, it is also safe to use a long term dressing.

Therefore, this study shows that long term dressing in elective congenital hand surgery is safe, without increased risk on adverse events.