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Cirugía Plástica Ibero-Latinoamericana

On-line version ISSN 1989-2055Print version ISSN 0376-7892


GARCIA-MARTINEZ, Irene et al. Pyogenic flexor tenosynovitis: experience in Central University Hospital of Asturias. Cir. plást. iberolatinoam. [online]. 2016, vol.42, n.2, pp.167-173. ISSN 1989-2055.

Background and Objectives. Pyogenic flexor tenosynovitis is a serious infection of the soft tissues of the hand. Kanavel signs are helpful for the diagnosis. The disease is associated to functional sequelae, from stiffness of metacarpophalangeal and interphalangeal joints to the need of digital amputations. A rapid administration of intravenous broad spectrum antibiotics and an urgent surgical drainage are mandatory in order to minimise the functional sequelae. The aim of our study is to make a description of the characteristics of the patients treated of this condition in our institution. Methods. We present a retrospective study of 24 cases of flexor sheath infections diagnosed and treated during an 8-year period by the Plastic and Reconstructive Unit of the Central University Hospital of Asturias. Results. Most affected fingers were the index and middle and in all cases one of the 4 Kanavel's signs was preset; 71% of our patients required emergency surgery: open drain 88%, 76% volar approach Bruner type, 6% longitudinal medial-lateral approach, and another 6% extensive debridement including skin. The others were treated with broad-spectrum intravenous antibiotic therapy, immobilization and elevation of the affected limb. In all cases intraoperative lavage with saline and/or antiseptic serum and 65% followed postoperative continuous irrigation. The most isolated germ was Staphylococcus aureus, while in 75% of cases not microbiological growth was obtained. The average hospital stay was 7.3 days. All the patients followed early rehabilitation; 42% achieved complete recovery, 29% suffered limited extension and 16% flexo-extension defficit of the afected finger. Conclusions. Our findings show that pyogenic flexor tenosynovitis is a rare condition in our area. It's important a correct diagnosis for early surgical drainage of the affected synovial sheath to improve the functional prognosis. The clinical presentation should guide us, but it is imperative high diagnostic suspicion to initiate appropriate treatment.

Keywords : Hand tenosynovitis; Pyogenic flexor tenosynovitis; Flexor sheath infection.

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