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Reoperation Rates in Flexor Tenosynovitis due to Methicillin-Resistant Staphylococcus aureus
Reece A Moore, MD, Jacob D Franke, MD; Matthew Fahrenkopf, MD
Michigan State University/Corewell Health, Grand Rapids, MI
Introduction: Urgent management of flexor tenosynovitis (FTS) is required due to its rapidly progressive nature and possible finger necrosis or devitalization. Guidelines for management of FTS often fail to incorporate microbiologic data despite the known relevance of causal bacteria in predicting outcomes in infectious processes elsewhere in the body. Our group aims to investigate if FTS secondary to methicillin-resistant
Staphylococcus aureus (MRSA) has an increased likelihood of requiring re-operation compared to cases of FTS with other culture confirmed microbiology.
Materials & Methods: A retrospective review of all patients presenting to a level 1 trauma center Hand Surgery service with an operative hand infection from 2024-2025 was conducted. Patients were evaluated by a member of the Hand Surgery team for confirmation of the hand surgery infection diagnosis, and surgical management was performed at the bedside or in the operating room. Variables collected for patients included demographic variables, type of infection, mechanism of injury, time to presentation, type of procedure, need for re-operation, nasal MRSA screen, and culture data. Tests of significance between groups were two-tailed t-tests and chi-square analysis. Statistical significance was accepted when p<0.05.
Results: Sixty-six patients presented to the Hand Surgery service with an operative hand infection. Seventeen (25.8%) of these patients were diagnosed with FTS. For patients diagnosed with FTS, the average age was 48.2 years-old and 29.4% were male. The most common mechanism of injury was laceration (41.2% , p>0.05). Bedside management with flexor tendon sheath irrigation was completed in 5/17 (29.4%) patients, and all other patients were managed with surgical management within the operating room. MRSA-positive cultures were found in 5/17 (29.4%) of FTS patients, and 60% of these patients required a re-operation compared to 8.3% of those with negative MRSA cultures (p=0.022). Location of initial intervention was not significantly associated with need for re-operation.
Conclusions: Hand infections due to MRSA have an increased re-operation rate. In FTS specifically, re-operation is significantly higher for patients with MRSA-positive cultures. Patient counseling and a suspicion for further surgical management should be influenced by microbiologic data.
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