4: Drainage of Purulent Flexor Tenosynovitis

Published on 17/04/2015 by admin

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Last modified 22/04/2025

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Procedure 4 Drainage of Purulent Flexor Tenosynovitis

Exposures

Procedure

Step 3: Closed Tendon Sheath Irrigation

Evidence

Abrams RA, Botte MJ. Hand infections: treatment recommendations for specific types. J Am Acad Orthop Surg. 1996;4:219-230.

This article presents recommendations for antibiotic treatment of hand infections. The authors clearly discuss treatment options for a variety of infectious conditions in the hand. (Level V evidence)

Lille S, Hayakawa T, Neumeister MW, et al. Continuous postoperative catheter irrigation is not necessary for the treatment of suppurative flexor tenosynovitis. J Hand Surg [Br]. 2000;25:304-307.

Retrospective review of 75 patients from two institutions comparing intraoperative débridement alone (20 patients) with postoperative catheter irrigation (55 patients). No statistically significant differences in outcomes were noted. (Level IV evidence)

Neviaser RJ. Closed tendon sheath irrigation for pyogenic flexor tenosynovitis. J Hand Surg [Am]. 1978;3:462-466.

The authors describe the use of the catheter irrigation technique presented in this chapter. In this retrospective study, 18 of 20 patients regained full active motion when treated with débridement and 48 hours of continuous irrigation of the sheath. This technique has withstood the test of time and is the recommended technique for the treatment of pyogenic flexor tenosynovitis. (Level IV evidence)

Pang HN, Teoh LC, Yam AKT, et al. Factors affecting the prognosis of pyogenic flexor tenosynovitis. J Bone Joint Surg [Am]. 2007;89:1742-1748.

This retrospective review demonstrated poor outcomes in patients who met one or more of five criteria: (1) age more than 43 years; (2) diabetes, vascular disease, or renal failure; (3) subcutaneous purulence; (4) digital ischemia; and (5) polymicrobial question. Patients could be stratified into expected outcome based on the presence or absence of these factors. (Level IV evidence)