This protocol addresses patients with flexor tendon sheath infection who present with three or more Kanavel signs alongside moderate to severe digit infection symptoms — in the absence of advanced, necrotic, or chronic tendon sheath involvement. The combination of multiple positive Kanavel signs with this symptom severity defines the threshold at which surgical management is indicated.
The structured approach for this presentation centres on surgical irrigation and debridement of the flexor tendon sheath, combined with an antibiotic regimen. Surgical access, irrigation technique, and the sequencing of intravenous and subsequent oral antibiotic therapy are defined in the full protocol.
Resolution of flexor tendon sheath infection within 2 to 6 weeks after surgery.
DOI: 10.1055/s-0039-1700370
In cases of advanced or delayed presentation, three or more Kanavel signs, and/or failure to respond to antibiotics after 24 to 48 hours, surgery is indicated.
The flexor sheath is then repeatedly irrigated with antibiotic-impregnated irrigation, until satisfied that the purulent fluid has been cleared away.
Oral antibiotics should ultimately be tailored to the intraoperative cultures, and should be continued for 2 to 6 weeks after surgery until clinically satisfied that the infection has fully resolved.
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