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Pyogenic flexor tenosynovitis: A current problem of hand surgery
Konstantin Lipatov1, Arthur Asatryan2, George Melkonyan3
1N.V. Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), 119021, Moscow, Russia.
Purpose:
Pyogenic flexor tenosynovitis is one of the most severe purulent diseases of the hand and is characterized by a high level of development of stiffness and contractures.
Methods:
This is a retrospective study conducted on patients hospitalized in our center in 2022. Patients diagnosed with pyogenic flexor tenosynovitis, aged from 18 to 90 years were included. Exclusion criteria are pregnancy or breastfeeding, concomitant oncological diseases, and collagen diseases. All patients were operated on urgently. Debridement, drainage and irrigation were performed. On the 4th-5th day after the operation, when the inflammation subsided, rehabilitation began. The long-term outcome was assessed throughout 3-12 months after discharge and was based on the restoration of the volume of active movements. The results are assessed according to the total active motion scale. Continuous variables were presented as median (Q1, Q3), and were compared using the Mann-Whitney U test. Categorical variables were expressed as n (%), and comparisons were made between the 3 groups using the Spearman's rank correlation coefficient. Statistical significance was defined as a 2-sided p < 0.05.
Results:
The results of the examination and treatment of 60 patients were analyzed. The frequency of pyogenic flexor tenosynovitis was 5.3% among all patients with purulent diseases of the hand during this period. Tendon necrosis was noted in 8 (13.3%) cases. Surgical treatment in 37 (61.7%) patients was completed with drainage and primary suture. The rest of the patients (23, 38.3%) underwent repeated debridement, which ended in 10 (16.7%) cases with the imposition of secondary sutures. The best recovery of function was noted in cases of maintaining the viability of the tendon.
Conclusions:
Timely diagnosis and provision of comprehensive surgical care for patients with pyogenic flexor tenosynovitis in combination with early rehabilitation should be considered the key to successful treatment of this complex category of patients.
