Factors associated to amputation in pyogenic flexor tenosynovitis in a tertiary referral center in Mexico

Authors

  • Carlos Altamirano-Arcos Department of Plastic, Aesthetic and Reconstructive Surgery, Dr. Manuel Gea González General Hospital, National Autonomous University of Mexico, México City, México
  • Enrique Chavez-Serna Department of Plastic, Aesthetic and Reconstructive Surgery, Dr. Manuel Gea González General Hospital, National Autonomous University of Mexico, México City, México
  • Ricardo Romero Caballero Department of Plastic, Aesthetic and Reconstructive Surgery, Dr. Manuel Gea González General Hospital, National Autonomous University of Mexico, México City, México
  • Carlos E. Rodriguez-Rodriguez Department of Plastic, Aesthetic and Reconstructive Surgery, Dr. Manuel Gea González General Hospital, National Autonomous University of Mexico, México City, México
  • Rogelio Martinez-Wagner Department of Plastic, Aesthetic and Reconstructive Surgery, Dr. Manuel Gea González General Hospital, National Autonomous University of Mexico, México City, México

DOI:

https://doi.org/10.18203/2349-2902.isj20233919

Keywords:

Tenosynovitis, Hand infection, Tendon infection, Hand surgery

Abstract

Background: Pyogenic flexor tenosynovitis is an aggressive closed-space infection, which affects the flexor tendon sheath of the hand with disabling sequelae. The purpose of this study is to describe the patient demographic characteristics and identify factors associated with amputation in pyogenic flexor tenosynovitis.

Methods: In this retrospective single-center study, included all adult patients who presented to the emergency department from 2015 to 2021 with PFT of the hand. Descriptive summary statistics were reported on patient demographics, presenting symptoms and clinical examination features, culture results, treatment strategies, and early complications. The factors influencing amputation were identified and analyzed.

Results: A total of 59 patients with PFT diagnosis were included. Most of the population was found to be immunosuppressed (34 patients). Moreover, the most common comorbidities were the combination of diabetes mellitus and systemic arterial hypertension. The third right finger was the most frequently affected region. Almost all patients were hospitalized, intravenous antibiotics, and at least one additional surgical intervention was required in 16 cases. Amputation of the infected finger occurred in 6 patients, associated with different factors: reintervention, age over forty, presence of diabetes mellitus and chronic arterial hypertension, penetrating trauma, and presence of Enterococcus faecalis in culture.

Conclusions: Rapid and aggressive treatment is required to prevent devastating complications such as amputation. Adequate identification of the disease and risk factors is critical for a successful result. E. faecalis represents the most common pathogen in this study, unlike the reported literature. Thus, broad-spectrum antibiotics and surgical intervention are required.

 

References

Giladi AM, Malay S, Chung KC. A systematic review of the management of acute pyogenic flexor tenosynovitis. J Hand Surg Eur Vol. 2015;40(7):720-8.

Brusalis CM, Thibaudeau S, Carrigan RB, Lin IC, Chang B, Shah AS. Clinical Characteristics of Pyogenic Flexor Tenosynovitis in Pediatric Patients. J Hand Surg Am. 2017;42(5):388.e1-5.

Chapman T, Ilyas AM. Pyogenic Flexor Tenosynovitis: Evaluation and Treatment Strategies. J Hand Microsurg. 2019;11(3):121-6.

Osterman M, Draeger R, Stern P. Acute hand infections. J Hand Surg Am. 2014;39(8):1628-35.

Draeger RW, Bynum DK Jr. Flexor tendon sheath infections of the hand. J Am Acad Orthop Surg. 2012; 20(6):373-82.

Dailiana ZH, Rigopoulos N, Varitimidis S, Hantes M, Bargiotas K, Malizos KN. Purulent flexor tenosynovitis: factors influencing the functional outcome. J Hand Surg Eur Vol. 2008;33(3):280-5.

Kennedy CD, Huang JI, Hanel DP. In Brief: Kanavel’s Signs and Pyogenic Flexor Tenosynovitis. Clin Orthopaed Relat Res. 2016;474(1):280-4.

Kennedy CD, Lauder AS, Pribaz JR, Kennedy SA. Differentiation Between Pyogenic Flexor Tenosynovitis and Other Finger Infections. Hand. 2017;12(6):585-90.

Sharma K, Pan D, Friedman J, Yu JL, Mull A, Moore AM. Quantifying the Effect of Diabetes on Surgical Hand and Forearm Infections. J Hand Surg Am. 2018; 43(2):105-14.

Pollen A. Acute infection of the tendon sheaths. Hand. 1974;6(1):21-5.

Jardin E, Delord M, Aubry S, Loisel F, Obert L. Usefulness of ultrasound for the diagnosis of pyogenic flexor tenosynovitis: A prospective single-center study of 57 cases. Hand Surgery and Rehabilitation. 2018;37(2):95-8.

Yi A, Kennedy C, Chia B, Kennedy SA. Radiographic Soft Tissue Thickness Differentiating Pyogenic Flexor Tenosynovitis From Other Finger Infections. J Hand Surg Am. 2019;44(5):394-9.

Ong YS, Levin LS. Hand infections. Plast Reconstr Surg. 2009;124(4):225-33.

Stern PJ, Staneck JL, McDonough JJ, Neale HW, Tyler G. Established hand infections: A controlled, prospective study. J Hand Surg. 1983;8(5):553-9.

Neviaser RJ. Closed tendon sheath irrigation for pyogenic flexor tenosynovitis. J Hand Surg. 1978; 3(5):462-6.

Wolfe SW, Pederson WC, Hotchkiss RN, Kozin SH, Cohen MS. Green’s Operative Hand Surgery E-Book. USA: Elsevier Health Sciences; 2016.

Glass KD. Factors related to the resolution of treated hand infections. J Hand Surg. 1982;7(4):388-94.

Trumble T. Principles of Hand Surgery and Therapy. USA: Saunders; 2010.

Pang H-N, Teoh L-C, Yam AKT, Lee JY-L, Puhaindran ME, Tan AB-H. Factors affecting the prognosis of pyogenic flexor tenosynovitis. J Bone Joint Surg Am. 2007;89(8):1742-8.

Müller CT, Uçkay I, Erba P, Lipsky BA, Hoffmeyer P, Beaulieu J-Y. Septic Tenosynovitis of the Hand: Factors Predicting Need for Subsequent Débridement. Plast Reconstr Surg. 2015;136(3):338-43.

Harris PA, Nanchahal J. Closed continuous irrigation in the treatment of hand infections. J Hand Surg. 1999;24(3):328-33.

Lille S, Hayakawa T, Neumeister MW, Brown RE, Zook EG, Murray K. Continuous Postoperative Catheter Irrigation is not Necessary for the Treatment of Suppurative Flexor Tenosynovitis. J Hand Surg. 2000;25(3):304-7.

Nikkhah D, Rodrigues J, Osman K, Dejager L. Pyogenic flexor tenosynovitis: one year’s experience at a UK hand unit and a review of the current literature. Hand Surg. 2012;17(02):199-203.

Downloads

Published

2023-12-27

Issue

Section

Original Research Articles