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Efficacy of Surgical Approaches for Treatment of Pyogenic Flexor Tenosynovitis
Trung Ho, MD; Ian McGraw, MS; Wendy L. Parker, MD, PhD
Baylor Scott & White, Temple, TX

Introduction: Pyogenic flexor tenosynovitis accounts for a large percentage of admissions to the hand service. Common surgical treatment of pyogenic flexor tenosynovitis includes wide exposure, irrigation, and debridement or minimally invasive catheter based irrigation. The efficacy of these surgical approaches and their indications have not been adequately studied. This study aimed to assess the efficacy of open versus catheter-based surgical treatment for pyogenic flexor tenosynovitis.

Methods: This is a retrospective chart review of patients who presented to our institution with pyogenic flexor tenosynovitis and underwent surgical treatment by Plastic Surgery or Orthopedic Surgery from 2004 to 2014. Data collected included duration of symptoms, initial surgical approach, length of hospitalization, duration of intravenous antibiotics, number of failed surgical treatments, and time to complete healing. Statistical analysis was performed comparing each primary endpoint between the two surgical approaches.

Results: 123 charts were reviewed including 54 cases of open surgical treatment and 69 cases of catheter-based treatment for pyogenic flexor tenosynovitis. The mean age was 40 years in catheter-based and 43 years in open treatment group. There was no significant difference between the groups in regards to sex, hand dominance, involved hand, high risk, duration of symptoms, length of hospital stay, or duration of IV antibiotics. Failure rate, defined in our study, as unanticipated return to the operating room for failure to clear infection after the initial operation, was 20.3% in the catheter group and 9.3% in the open group which was statistically significant. Average time to complete healing for patient with successful initial treatment was 40.7 days for the catheter-based group and 45.4 days for the open group.

Conclusions: Minimally invasive catheter based treatment for pyogenic flexor tenosynovitis offers several advantages compared to traditional wide open incision and debridement. Due to its inherent disadvantages in being limited exposure; however, not all cases of flexor tenosynovitis should be treated with this surgical approach. Further prospective randomized controlled studies are needed to compare the two surgical approaches and guide clinical management for efficient patient care without compromising outcome.

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