Early versus Delayed Surgical Treatment in Open Hand Injuries: A Paradigm Revisited Bernhard Angly • Mihai A. Constantinescu • Janett Kreutziger • Bettina H. Juon • Esther Vo ¨gelin Published online: 7 February 2012 Ó Socie ´te ´ Internationale de Chirurgie 2012 Abstract Background To date it remains unclear if a delayed sur- gical treatment of open hand injuries after more than 6 h may be detrimental to outcome. Previous investigations by McLain et al. (J Hand Surg Am 16:108–112, 1980 9), Nylen and Carlsson (Scand J Plast Reconstr Surg 14:185–189, 1991 10) could not find statistical proof of correlation between infection rate and delayed surgical treatment after open hand injuries up to 18 h. The current study was designed to investigate the outcome of early versus delayed surgical treatment after open hand injury. Patients and methods A retrospective data analysis of all patients sustaining an open hand injury between January 1 and December 31 2006 was performed. Patients with incomplete data records were excluded. Patients were stratified according to time delay of surgical treatment and injury complexity. Complications, revision rate, and func- tional outcome were also investigated. Results Between January 1 and December 31 2006 a total of 458 patients with open hand injuries were treated at the University Hospital of Berne, Switzerland. The records were retrospectively analyzed and a subgroup of 100 patients were randomly determined for standardized follow-up evaluation. There were no significant differences regarding infection, complication, and revision rate between early ( \ 6 h) and delayed (6–24 h) surgical treatment of open hand injuries. Independently from the time point of surgical treatment, patients with complex injuries and longer operative times had an increased infection rate (p = 0.05) and revision rate (p = 0.003). Conclusions Delayed surgical treatment (6–24 h) of open hand injuries did not increase infection or revision rates in open non-devascularizing hand injuries. Introduction Will the delayed surgical treatment of open hand injuries after more than 6 h influence the outcome in a negative manner? In the historical literature [1] general surgical treatment was requested within 6 h after trauma to prevent wound infections. However, this standard was established before the introduc- tion of prophylactic antibiotic therapy [2]. In general trauma studies, investigations of open lower limb fractures showed no correlation between infection rate and delayed surgical treatment up to 24 h [3–8]. In more recent hand injury related literature, McLain et al. [9] reported 11% infection rates in open fractures of the hand, but they found no differences between early and delayed treatment. Neither did Nylen Bernhard Angly and Mihai A. Constantinescu contributed equally to this work. B. Angly Orthopaedic and Hand Surgery, Hirslanden Clinic Birshof, Reinacherstrasse 28, 4142 Mu ¨nchenstein, Switzerland e-mail: bernhard.angly@sec.hirslanden.ch M. A. Constantinescu Á B. H. Juon Á E. Vo ¨gelin Department of Plastic, Reconstructive and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse, 3010 Bern, Switzerland e-mail: mihai.constantinescu@insel.ch B. H. Juon e-mail: bettina.juon@insel.ch E. Vo ¨gelin e-mail: esther.voegelin@insel.ch J. Kreutziger (&) Department of Anaesthesia and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria e-mail: janett.kreutziger@uki.at 123 World J Surg (2012) 36:826–829 DOI 10.1007/s00268-012-1455-x