Purulent Flexor Tenosynovitis: Factors Influencing the Functional Outcome

Abstract

This retrospective study aimed to evaluate the factors that influence the final outcome of treatment of purulent flexor tenosynovitis, viz. delay in treatment, severity of the condition, the infecting pathogen and the method of treatment. Of 41 patients with this condition treated by drainage and irrigation through two small incisions (16) and wide incision (25), 16 were treated after a delay. Continuous postoperative irrigation was applied in 26 patients. Re-operation was necessary in 11 patients. In most cases, Staphylococcus aureus was detected. The results were excellent in 32 cases and the mean Disabilities of the Arm, Shoulder and Hand score was 8.1. Irrigation through small incisions and continuous postoperative irrigation decreased the probability of an unfavourable outcome. Delayed treatment and infections with specific pathogens led to a worse outcome. Early diagnosis of purulent flexor tenosynovitis followed by drainage through small incisions and continuous postoperative irrigation appear, from this retrospective review, to lead to the best functional outcome.

Hand Infections: Anatomy, Types and Spread of Infection, Imaging Findings, and Treatment Options

“…Knowledge of the exact location, extent, and mode of spread of the infection helps determine the appropriate surgical intervention. A detailed knowledge of the anatomy of the tendon sheaths, adjacent anatomic compartments, and deep spaces of the hand is essential for adequate treatment of hand infections, which often originate from, or expand into, multiple deep spaces or compartments (8)(9)(10). Thus, it is necessary for of the metacarpal neck distally up to the distal interphalangeal joint (14).…”

“…Body temperature, C-reactive protein level, and erythrocyte sedimentation rate may not be elevated and hence may not be useful (1). Infections with specific pathogens, extension of infection, and delayed treatment are associated with a worse outcome (8). the radiologist to inform the surgeon of the presence, location, and extent of the infection.…”

Die Beugesehnenscheideninfektion: Eine Übersicht

“…Heute werden durch eine fr ü hzeitige operative Therapie mit auf das Notwendige reduzierten Hautschnitten, Sp ü lungen, begleitender antibiotischer Therapie und fr ü hzeitiger Mobilisation zu einem hohen Prozentgrad sehr gute Ergebnisse erzielt. Die wichtigsten Faktoren f ü r schlechte Endergebnisse sind versp ä teter Behandlungsbeginn, Infektion mit ungew ö hnlichen Keimen[31] , diabetische Stoff wechsellage und Bissverletzungen[107] . Die Ergebnisse der Literatur lassen sich nur eingeschr ä nkt miteinander vergleichen.…”

Two-Stage Tendon Sheath Reconstruction Using Sublimis Tendon and Silicone Penrose Drain after Severe Purulent Flexor Tenosynovitis: A Case Report

“…In case of purulent flexor tenosynovitis, early diagnosis followed by immediate surgical treatment with administration of antibiotics is widely recognized as a golden rule [7,8,15]. Without prompt treatment, infection within the sheath quickly worsens and consequently devitalizes the tendon sheath, the overlying skin, and occasionally, the tendon itself.…”

“…In such cases, severe functional deficit remains, even after the infection has receded. Although many reports have focused on the initial stages of treatment, such as irrigation, debridement, and drainage [7,14,15], detailed discussions of secondary functional reconstruction are scarce. Poor prognosis due to total peritenon failure with partially survived flexor tendons and tendinous adhesions is possible in the progressive stage of flexor tenosynovitis (stage III in Michon classification [11] and stages III to IV in Loudon classification [8]).…”