Mr Justin Wormald

Each year, over 250,000 people in the UK undergo surgery for injuries to the hand and wrist. Infections after these procedures are a serious complication that can delay recovery, reduce hand function, and cause long-term problems — yet the true risk remains unclear.

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This research aims to define how often post-surgical infections occur after hand trauma and to explore ways to reduce them.

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What this fellowship set out to explore

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With support from a Blond McIndoe Surgical Research Fellowship, plastic surgery trainee Justin Wormald began his DPhil at the University of Oxford, focusing on the risk of infection after hand and wrist trauma surgery.

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Working under Professor Matthew Costa at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), he set out to answer two key questions:

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1. What is the real risk of infection following hand trauma surgery?

2. Can using antimicrobial sutures — stitches coated with bacteria-killing agents — help reduce this risk?

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What the team found

• Justin conducted one of the largest systematic reviews in hand surgery to date, analysing 171 studies involving over 30,000 patients. He found reported infection risks varied widely (0–47%), with better-quality studies suggesting rates around 5–10%.

• To get a more accurate picture, he analysed data from 19 million NHS hospital records spanning 20 years, identifying thousands of patients who needed further surgery or hospital admission due to infection after hand trauma. This created the most detailed infection risk dataset ever compiled for hand surgery.

• These findings helped inform new national guidance from the British Society for Surgery of the Hand (BSSH) and the Getting it Right First Time (GIRFT) initiative.

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Why this matters

Hand injuries are among the most common injuries seen in emergency departments, particularly affecting young working-age adults. Even minor post-operative infections can have a major impact — delaying return to work and reducing independence.

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This research provides the clearest picture to date of infection risks and helps guide shared decision-making between patients and surgeons. It also sets the stage for evaluating practical ways to reduce infections, such as using antimicrobial sutures.

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The wider impact

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Justin has launched the first feasibility study of antimicrobial sutures in hand trauma surgery, which began recruiting patients in 2022. While these sutures are already used in other types of surgery, they’ve never been studied in the context of hand injuries — a population with different risk factors and needs.

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As he explains:

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“It would not have been possible for me to get going on my DPhil research without this funding. The RCS and Blond McIndoe stepped in at a critical time when most funding was focused on COVID-19. Their support gave me the springboard I needed.”

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Next steps

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Justin will complete his DPhil and continue analysing the results of the antimicrobial suture study. His long-term goal is to lead research into trauma and reconstructive surgery as an academic consultant, ensuring that future care for hand trauma patients is firmly grounded in high-quality evidence.