Use of continuous marcaine irrigation in the management of suppurative flexor tenosynovitis

We describe a surgeon, nursing, and patient-friendly method of treating acute pyogenic tenosynovitis using a 2-incision, closed sheath irrigation method and postoperative usage of a continuous marcaine ON-Q pain pump. The advantages of this technique include the ease of catheter placement intraoperatively and the use of a smaller diameter tubing within the flexor sheath. In addition, this technique eliminates the need for nursing staff to perform irrigation, and most importantly, the technique results in improved postoperative pain control allowing an early aggressive postoperative therapy protocol. We retrospectively reviewed 9 patients with an average age of 42.8 years (range: 20 to 66 y) who presented with acute pyogenic flexor tenosynovitis. All patients underwent surgery on the day of presentation to us with the described technique with the catheter left in place for 2 days. Outcome measurements included length of hospital stay, final range of motion, recurrence of infection, and complications. Average hospital stay was 2.8 days (range: 2 to 6 d). There were no recurrent infections. Seven patients regained full total active motion of the involved digit. The 2 patients with incomplete recovery of digital motion regained 125 and 105 degrees of total active motion, respectively. In addition, there were 3 minor complications including cold intolerance (2 patients) and local skin necrosis that responded to local wound care (1 patient). This novel method of managing acute flexor tenosynovitis seems to be safe, effective, and very friendly for surgeons, nurses as well as patients. Intraoperative pearls for catheter placement using a 22-guage wire inside a musical sharp5 pediatric French feeding tube are also described.