» The use of preoperative antibiotic prophylaxis is not supported for elective cases of patients undergoing soft-tissue hand procedures that are ≤2 hours in length. » The use of preoperative antibiotic prophylaxis is not supported for patients with diabetes undergoing elective, soft-tissue hand surgical procedures. » There is a paucity of literature evaluating the use of preoperative antibiotic prophylaxis in patients with rheumatoid arthritis, those with cardiac valves, and those taking corticosteroids; because of this, there is no evidence to vary from our general recommendations. Surgical site infections are a major source of morbidity and impose a large economic burden in orthopaedic surgery 1-3. Preoperative antibiotic prophylaxis is commonly used to prevent surgical site infection. Although there is evidentiary support for the use of preoperative antibiotic prophylaxis for many orthopaedic procedures (e.g., open fractures 4-6 , lowerextremity fractures 7-9 , and total joint replacement 10-12), the use of preoperative antibiotic prophylaxis for elective soft-tissue hand surgical procedures is controversial 13,14. For example, current recommendations from the American Association of Plastic Surgeons are to not utilize preoperative antibiotic prophylaxis for clean hand surgical procedures, and current recommendations from the American Academy of Orthopaedic Surgeons are to not utilize preoperative antibiotic prophylaxis for carpal tunnel release 15,16. Despite these recommendations, 2 surveys of hand surgeons reported rates of antibiotic use for carpal tunnel syndrome between 31% and 49% 17,18. Although millions of soft-tissue hand procedures are performed each year 19,20 , the rate of infection is reported to be low, with studies showing infection rates between 0.3% and 1.5% 13,21-25 for elective cases (e.g., carpal tunnel release and trigger finger release). Although the rate of infection for urgent soft-tissue cases is reported to be higher (e.g., 1.1% to 9.8% for lacerations, open fractures, or bite injuries 26-28), this review will focus on elective soft-tissue surgical procedures (e.g., carpal tunnel release, trigger finger release, Dupuytren contracture release). Despite the low rate of infections, complications can be devastating, leading to soft-tissue loss, stiffness, scarring, and amputation 29. Preoperative antibiotic prophylaxis, given to prevent infection, is associated with its own complications,