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Treatment of digital pyogenic flexor tenosynovitis: single open debridement, irrigation, and primary wound closure followed by antibiotic therapy

  • Handsurgery
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Abstract

Introduction

Digital pyogenic flexor tenosynovitis requires fast, aggressive treatment. Although this infection occurs frequently, treatment consensus is lacking.

Materials and methods

Between 2011 and 2015, 22 patients with acute pyogenic flexor tenosynovitis were treated with a single open debridement followed by irrigation; the incision was closed and a 10-day antibiotic course was administered. The average incision-to-suture time was 25 min, and the average hospital stay was 4 days. Recovery was uncomplicated for 20 patients, while two were reoperated, one due to germ resistance and the other due to necrotizing fasciitis. At an average of 30 month postoperatively, 21 of the 22 patients were available for follow-up. The affected finger was inspected, and sensibility, range of motion, and grip force were compared with the opposite side, and the DASH score was determined. Each patient documented pain in the affected finger at rest and during activity, and rated overall satisfaction with the treatment on a visual analogue scale.

Results

Almost all patients were free of pain at follow-up and very satisfied. Compared to the contralateral side, each of the affected fingers had the same range of motion and sensibility. Grip force was similar on both sides. The average DASH score was 35 points.

Conclusion

A single open debridement with irrigation and primary wound closure followed by 10 days of antibiotic treatment resolved uncomplicated pyogenic flexor tenosynovitis. After 2 and a half years, the treatment yielded high patient satisfaction with neither functional nor subjective impairment of the affected finger.

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Acknowledgements

We would like to thank Christopher Ritter, PhD, for assistance and preparation of the manuscript.

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Authors and Affiliations

  1. Abteilung für Hand-, Ästhetische und Plastische Chirurgie, Elbe Klinikum Stade, Stade, Germany

    Bernd Hohendorff, H. Sauer & F. Biber

  2. Klinik für Unfallchirurgie und Orthopädie, Elbe Klinikum Stade, Stade, Germany

    J. Franke

  3. Handchirurgie, Vulpius Klinik, Bad Rappenau, Germany

    C. K. Spies

  4. Unfall-, Hand- und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum zu Köln, Cologne, Germany

    L. P. Müller & C. Ries

Authors
  1. Bernd Hohendorff
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  2. H. Sauer
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  3. F. Biber
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  4. J. Franke
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  5. C. K. Spies
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  6. L. P. Müller
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  7. C. Ries
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Correspondence to Bernd Hohendorff.

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Funding statement

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of interest

All named authors hereby declare that they have no conflicts of interest to disclose.

The study was approved by the university’s ethics committee and conformed to the Declaration of Helsinki.

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Hohendorff, B., Sauer, H., Biber, F. et al. Treatment of digital pyogenic flexor tenosynovitis: single open debridement, irrigation, and primary wound closure followed by antibiotic therapy. Arch Orthop Trauma Surg 137, 141–145 (2017). https://doi.org/10.1007/s00402-016-2587-5

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  • DOI: https://doi.org/10.1007/s00402-016-2587-5

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