The Treatment of Purulent Flexor Tenosynovitis

The foundation of the successful management of purulent flexor tenosynovitis is the surgical debridement followed by an intravenous antibiotic treatment. Several surgical methods have been described to remove the purulent debris from the flexor tendon sheath. Closed-catheter irrigation involves irrigation of the tendon sheath from proximal to distal direction facilitated by two small incisions; one proximal to A1 pulley and one distal to A4 pulley. Lille et al. (J Hand Surg Br. 2000;25(3):304-307) conducted a retrospective study that implied that intraoperative closed-catheter irrigation without postoperative irrigation might be as effective as the combination of intra- and postoperative irrigation.

The hypothesis of this prospective randomized trial is that the intraoperative closed-catheter irrigation alone is as effective as the combination of intraoperative and postoperative intermittent closed-catheter irrigation in the treatment of purulent flexor tenosynovitis.

Inclusion criteria

• clinical diagnosis of purulent flexor tenosynovitis with all four positive Kanavel's signs:

• symmetric swelling of the entire digit
• exquisite tenderness along the course of the tendon sheath
• semiflexed posture of the digit
• pain with attempted passive extension of the digit
• age over 18 years
• patient's willingness to participate in the study

Exclusion criteria

• High-pressure, foreign body or chemical injuries, which require open debridement
• prisoner, military serviceman, mental retardation or other factors which may affect one's decision making