Treatment of Infectious Tenosynovitis with Advanced, Necrotic, or Chronic Flexor Tendon Sheath Infection
Clinical Scenario
This protocol applies when infectious tenosynovitis has progressed to an advanced or chronic stage — including cases with necrosis of the tendon or pulleys — where the flexor tendon sheath infection cannot be adequately managed by less invasive means. In the most severe stage, septic necrosis of the tendon and pulleys may be present.
Approach
Management in this scenario centres on a surgical intervention to directly address the infected sheath, combined with systemic antibiotic therapy — the specifics of which are guided by intraoperative findings. The full structured regimen is available via the link below.
Treatment Goal
Resolution of the flexor tendon sheath infection, confirmed clinically, within the postoperative period.
References
DOI: 10.1055/s-0039-1700370
- Open irrigation and debridement may be utilized for more advanced cases of infection and in cases of atypical or chronic tenosynovial infections.
- In the third stage, there is septic necrosis of the tendon and the pulleys.
- Midaxial or volar Brunner-type incisions can be utilized to expose and open the entire flexor tendon sheath for thorough debridement.
- Regardless of the pathogen, management of PFT includes prompt administration of empiric intravenous antibiotics.
- 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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