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Risk of septic spread during surgical management of digital flexor tendon sheath phlegmon: Exsanguination by
K Erdogan1, F Lefebvre2, F Xavier3
1Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France.
Abstract:
This study aimed to demonstrate that there was no risk of extension of infection in performing mechanical exsanguination before inflating the tourniquet for surgical treatment of digital flexor tendon sheath phlegmon. The series comprised 96 patients, with a mean age of 47 years (range, 18-87 years) and 37 women. Group I included 47 patients in whom exsanguination was performed with a Velpeau band before inflating the pneumatic tourniquet at the root of the limb. In Group II, which included 49 patients, the tourniquet was inflated after simple elevation of the limb. Six patients underwent revision surgery for recurrence or osteoarticular complications: 4 (8.5%) in Group I and 2 (4.1%) in Group II, the difference between two groups being non-significant (p = 0.6378). In conclusion, mechanical exsanguination before inflating the tourniquet did not incur risk of complications in surgical management of digital flexor tendon sheath phlegmon.
Insights
Performing mechanical exsanguination before tourniquet inflation for digital flexor tendon sheath phlegmon surgery poses no increased infection risk. This surgical technique is safe for managing this condition.
Area of Science:
- Orthopedics
- Hand Surgery
- Infectious Disease Management
Background:
- Digital flexor tendon sheath phlegmon requires surgical intervention.
- The use of tourniquets is common in such procedures.
- Concerns exist regarding potential infection spread with pre-tourniquet exsanguination.
Purpose of the Study:
- To evaluate the safety of mechanical exsanguination prior to tourniquet inflation in treating digital flexor tendon sheath phlegmon.
- To determine if this method increases the risk of infection extension or other complications.
Main Methods:
- A comparative study of 96 patients undergoing surgery for digital flexor tendon sheath phlegmon.
- Group I (47 patients): Mechanical exsanguination with a Velpeau band before tourniquet inflation.
- Group II (49 patients): Tourniquet inflation after simple limb elevation.
Main Results:
- Six patients required revision surgery for complications (4 in Group I, 2 in Group II).
- The complication rate difference between groups was not statistically significant (p=0.6378).
- Mechanical exsanguination did not lead to a higher incidence of recurrence or osteoarticular issues.
Conclusions:
- Mechanical exsanguination before tourniquet inflation is a safe adjunct in the surgical management of digital flexor tendon sheath phlegmon.
- This technique does not elevate the risk of infectious complications or other adverse outcomes.
- The study supports the routine use of pre-tourniquet exsanguination in this surgical context.
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