Space of Parona infections: experience in management and outcomes in a regional hand centre

Space of Parona Infection is a rare and potentially limb threatening complication of pyogenic flexor tenosynovitis. The aim of this study is to review the presentation, management and outcomes of space of Parona infections in our institution.

This was a retrospective study. Data was collected from patients with confirmed space of Parona infections determined by the presence of pus in this space during the initial surgical debridement; between 2009 and 2011. The following parameters were analysed: patient demographics, presentation, microbiological findings and surgical management. The outcomes assessed included the final active range of motion of the primary affected finger, rate of amputation and duration of hospital stay and follow up.

There were nine confirmed space of Parona infections. 7/9 patients reported a history of trauma. The thumb (7/9) followed by the little finger (2/9) were primarily involved in all cases. Seven patients presented with symptoms of acute median nerve compression in addition to forearm tenderness. Patients had a mean of two (range; 1-5) visits to theatre for washout and debridement. Positive swabs were present in 8/9 cases, of which five patients cultured β haemolytic streptococci. Average hospital stay was six days (range; 3-12) and final active range of movement of the affected finger ranged from 0 to 95%.

Involvement of space of Parona should be suspected in patients with flexor tendon sheath infections of the thumb or little finger. Early antimicrobial therapy directed particularly at β haemolytic streptococcus combined with prompt surgical debridement and physiotherapy are critical to optimal functional outcome.