Introduction: The delivery of regional antibiotic prophylaxis has been described in reconstructive knee surgery as well as in the management of hand injuries. In this study, we describe a technique for the delivery of regional antibiotic prophylaxis to the upper extremity in patients undergoing elbow surgery, and compare tissue antibiotic concentrations achieved with this technique to those achieved with standard systemic intravenous antibiotic prophylaxis.

Methods: We collected bone and fat samples from eight patients undergoing elective elbow surgery who had received regional antibiotic prophylaxis, and measured tissue antibiotic concentration by high performance liquid chromatography. In these patients, prior to the surgical incision, we exsanguinated the arm, inflated the tourniquet, and delivered a standard dose of Cephazolin into a dorsal hand vein. For comparison, we measured antibiotic concentrations in bone and fat samples taken from eight patients undergoing elective shoulder surgery who had received standard systemic antibiotic prophylaxis.

Results: Mean tissue antibiotic concentrations were significantly higher in the patients who received regional antibiotic prophylaxis compared with those who received standard systemic prophylaxis (Bone: 1060 mcg/gm versus 41 mcg/gm; Fat: 649 mcg/gm versus 10 mcg/gm; p < 0.05.)

Discussion/conclusions: The delivery of regional antibiotic prophylaxis in elbow surgery achieved higher tissue antibiotic concentrations than those achieved with standard systemic delivery. This technique may help reduce the risk of acute infection in elbow surgery, and may be especially valuable in elective surgery in predisposed patients (e.g. rheumatoid arthritis), in the management of open fractures, as well as in protection against particularly virulent organisms.