Severity of upper-limb panga injuries and infection rates associated with early v. late tendon repair.

BACKGROUND

Panga or machete attacks are a common cause of significant upper-limb trauma in South Africa. Pangas are a multipurpose household tool used predominantly for foraging and agricultural purposes and are highly contaminated. While some centres advocate immediate primary repair if no concern exists regarding the risk of infection, others delay definitive repair until satisfied there is no evidence of infection.

OBJECTIVES

To compare infection rates and tendon re-rupture following early primary repair (within 24 h), primary repair after 24 h, and delayed repair following initial debridement.

METHODS

We conducted a multicentre, retrospective, observational study of 49 patients (mean age 28.9 years; range 17 - 69), who were followed up for a mean of 3.4 months (range 0 - 8). The injuries sustained included 32 flexor tendon injuries, 14 extensor tendon injuries, 9 fractures and 21 peripheral nerve injuries.

RESULTS

Of the patients, 17 underwent early primary repair (within 24 h), 19 delayed primary repair, and 13 delayed repair following primary washout. Wounds were assessed postoperatively using the ASEPSIS wound scoring system and patients were clinically assessed for tendon rerupture. No significant differences were found in the comparative infection rates for early primary repair (5.9%; 1/17), delayed primary repair (10.5%; 2/19) and delayed repair following primary washout (23.1%; 3/13; p=0.662).

CONCLUSION

Our results indicate indicate that panga injuries can be repaired safely at first presentation with no increased risk of infection or re-rupture.