Factors Affecting the Prognosis of Pyogenic Flexor Tenosynovitis

Abstract

We propose a three-tier clinical classification system that can aid in prognosis and guidance in the treatment of pyogenic flexor tenosynovitis of the upper extremity.

Peroneal Tendon Reconstruction and Coverage for Treatment of Septic Peroneal Tenosynovitis: A Devastating Complication of Lateral Ankle Ligament Reconstruction With a Tendon Allograft

“…The Kanavel signs used to diagnosis septic flexor tenosynovitis of the upper extremity, in descending order of appearance on presentation, are fusiform swelling, pain on passive extension of the digit, a semiflexed posture of the digit, and tenderness to palpation along the tendon sheath. As reported by Pang et al (17), the 3 stages of flexor tenosynovitis, defined using the Michon classification (17), are stage 1, an inflamed and distended tendon sheath with serous exudate; stage 2, progressive distension of the tendon sheath with purulent exudate; and stage 3, septic necrosis of the tendons and the tendon pulleys. Progression through the stages was proposed to depend on the infecting organism's virulence and the response to treatment.…”

“…The recommendation for surgical intervention in this group is also open debridement, with consideration of early amputation to limit the period of morbidity, especially if signs of digital ischemia and necrosis are present or if the response to open debridement is poor. Using these guidelines, the present patient would have been in group II, for which open debridement is recommended (17). Polymethylmethacrylate cement beads were used in the present patient, because they have been shown to be an effective adjuvant therapy to aggressive irrigation and debridement in soft tissue infections of the foot and ankle (31).…”

“…Most of the published studies on flexor tenosynovitis have focused on the wrists and hands. Most of these cases have been secondary to atypical bacteria, fungus, or normal skin flora secondary to complications related to intravenous drug use (17,18). Only 4 case reports specific to septic peroneal tenosynovitis were found in the published studies.…”

(iii) Hand infections

“…Poor prognostic factors include increasing age, polymicrobial infection, co-morbidities of diabetes mellitus, peripheral vascular disease and renal failure, late presentation with subcutaneous purulence and digital ischaemia. 5 If caught very early, before the infection has become purulent, it may respond to intravenous antibiotics, elevation, splintage and close observation. However, clinicians should have a low threshold for surgical exploration and washout of the sheath due to the grave consequences of permanent disability seen in untreated infections.…”

Septic Flexor Tenosynovitis

“…Group 3 (subcutaneous purulence and digital ischemia) had the worst results, with 59% amputations and only 49% TAM. 2 Maloon et al retrospectively examined the outcomes of 42 patients treated by open debridement of the tendon sheath without subsequent continuous irrigation. They identified 3 poor prognostic variables: (1) diabetes (none had good results), (2) human bites (none had good results), and (3) late presentation (more than 7 days, all had poor results).…”