Esmarch Exsanguination in Acute Hand Infections: Evaluating Risk of Infection Spread.

This study aimed to evaluate the infection-related complication rates associated with the use of Esmarch exsanguination compared with gravitational exsanguination in patients undergoing surgery for acute hand and forearm infections. A retrospective cohort study was conducted from December 2020 to March 2024 at a level 1 trauma center. Adult patients with acute hand or forearm infections who underwent irrigation and debridement (I&D) within 21 days of symptom onset were included. Patients with systemic infection at admission were excluded. The incidence of infection-related complications, including repeat I&D, hematological spread of infection, and 30-day readmission, was compared between those who underwent Esmarch exsanguination and those who did not, using Fisher exact test. The study included 80 patients, 33 in the Esmarch group and 47 in the non-Esmarch group. The overall complication rate was 15.2% in the Esmarch group compared with 8.5% in the non-Esmarch group. Repeat I&D was required in 12.1% of Esmarch patients versus 6.4% of non-Esmarch patients. Hematological spread occurred in one patient in each group, and readmissions were 9.1% in the Esmarch group compared with 2.1% in the non-Esmarch group. There was no statistically significant difference in the rates of infectious complications between the Esmarch and non-Esmarch groups. This study challenges the longstanding avoidance of Esmarch exsanguination in the context of acute hand infections, suggesting that its use does not significantly increase the risk of infection-related complications. These findings suggest that surgeons may consider the use of Esmarch exsanguination in hand surgery without a significant increase in infection-related risks, potentially improving surgical visualization and outcomes. Further studies are needed to confirm these results.