What is the appropriate management for a 63-year-old male patient with a superficial foreign object, measuring 3 mm, in his right second digit, visible on X-ray, which was removed using local Lidocaine (lidocaine) 1% anesthesia, a #10 blade, and closed with 3-0 silk sutures?

From the Guidelines

The patient should be prescribed a brief course of systemic antimicrobial therapy, such as a first-generation cephalosporin, due to the surgical site infection risk associated with the foreign body removal procedure on the extremities. The procedure involved removing a 3 mm superficial foreign object from the patient's right second digit that was previously identified on an X-ray dated January 22,2025. I administered local anesthesia using 1% lidocaine, made an incision with a #10 surgical blade to access the foreign body, and closed the wound with three 3-0 silk sutures. The patient tolerated the procedure well, and I confirmed that the removed object matched what was visible on the X-ray.

According to the practice guidelines for the diagnosis and management of skin and soft tissue infections, updated by the Infectious Diseases Society of America in 2014 1, a brief course of systemic antimicrobial therapy is indicated in patients with surgical site infections following clean operations on the trunk, head and neck, or extremities that also have systemic signs of infection. Although the patient does not currently exhibit systemic signs of infection, the guidelines recommend considering antimicrobial therapy for surgical site infections associated with a significant systemic response, such as erythema and induration extending >5 cm from the wound edge, temperature >38.5°C, heart rate >110 beats/minute, or white blood cell (WBC) count >12 000/µL.

Key considerations for the patient's post-procedure care include:

• Monitoring for signs of infection, such as increased redness, swelling, or purulent discharge
• Keeping the wound clean and dry until suture removal
• Removing the 3-0 silk sutures in approximately 7-10 days
• Administering the prescribed antimicrobial therapy as directed to minimize the risk of surgical site infection.

From the Research

Procedure Details

• The patient underwent a procedure to remove a foreign object from the R second digit.
• The object was 3 mm in size and visible on an X-ray from 01/22/2025.
• Local lidocaine 1% was used for anesthesia, and a 10 blade was used for access.
• Three sutures with 3-0 silk were given, and the patient tolerated the procedure well.

Infection Prevention

• There is no direct evidence from the provided studies to support the use of antibiotics for this specific procedure 2, 3, 4, 5, 6.
• A study from 1983 found that prophylactic antibiotics do not decrease the incidence of infection in patients with suture closure of simple lacerations 6.
• Another study from 1993 provides guidelines for antimicrobial prophylaxis for surgical wounds, but does not specifically address the use of antibiotics for foreign object removal 5.
• The use of antiseptics and antibiotics for surgical wounds healing by secondary intention was reviewed in a 2016 study, but the evidence was found to be low quality and inconclusive 3.

Antibiotic Use

• Cephalexin is an effective antibiotic for the treatment of streptococcal and staphylococcal skin infections, but its use in this specific case is not supported by the provided evidence 2, 4.
• A study from 2023 compared twice-daily and four-times-daily cephalexin dosing for the treatment of uncomplicated urinary tract infections, but this is not relevant to the current procedure 4.