This protocol applies to patients with early or mild flexor tendon sheath infection — fewer than three Kanavel signs, mild or atypical digit symptoms, presentation typically within 48 hours of penetrating hand trauma, and no fluctuance — who were initially managed conservatively but have not achieved the expected clinical response.
Patients with fewer than three Kanavel signs and mild or atypical symptoms of digit infection may initially be candidates for nonsurgical management, particularly when the presentation is early and fluctuance is absent. Clinical evaluation is always required to determine whether nonoperative or operative intervention is appropriate.
This step is reached when empiric intravenous antibiotics — covering gram-positive organisms including Staphylococcus and MRSA, Streptococcus species, gram-negative rods, and anaerobes, alongside hospital admission and frequent examination of the affected hand — have not resulted in improvement of clinical symptoms of digit infection within 24 to 48 hours.
When the expected response to conservative management is not achieved, the protocol moves to a surgical approach involving irrigation and debridement of the flexor tendon sheath. The full operative sequence, antibiotic delivery strategy, and post-operative antibiotic course — including duration and culture-directed tailoring — are specified in the complete protocol.
DOI: 10.1055/s-0039-1700370