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Infection

, Volume 47, Issue 2, pp 225–231 | Cite as

Current opinions regarding the management of pyogenic flexor tenosynovitis: a survey of Pulvertaft Hand Trauma Symposium attendees

  • L. E. BoltonEmail author
  • C. Bainbridge
Original Paper
  • 149 Downloads

Abstract

Purpose

Pyogenic flexor tenosynovitis (PFT) is recognized as a severe infection of the hand with potentially disastrous outcomes. The mainstay of treatment has been emergent surgical washout. Recent evidence suggests potential for conservative management with a combination of intravenous antibiotics, elevation and splinting. We aim to determine current management of PFT to guide further education and research.

Method

An electronic survey was distributed to attendees at the Pulvertaft Hand Trauma Symposium in May 2017. The survey was also sent to previous attendees. The survey was compiled by hand surgeons and piloted within a tertiary centre prior to dissemination. Questions focused on three clinical vignettes describing PFT of increasing severity. Responses were analyzed using Surveymonkey.

Results

A total of 91 clinicians responded. Almost 50% would proceed to surgical decompression and washout even in patients diagnosed early. This increased to 88% when treating a patient whose diagnosis was delayed. The majority of those advising surgery felt this should be within 24 h. More than 50% advocate active mobilization either immediately or as soon as possible regardless of severity. Almost all would use either general or regional anaesthesia and a two-incision technique with catheter irrigation.

Conclusions

Our survey demonstrates large variation in the management of PFT. Advice from the pre-antibiotic era continues to be followed with some clinicians continuing to advocate open surgery. There is substantial discrepancy regarding duration of immobilization. Further investigation into the management and outcomes of PFT is required to establish best practice guidelines for this rare but potentially devastating condition.

Keywords

Infection Flexor tendon sheath Pyogenic flexor tenosynovitis 

Notes

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

15010_2018_1236_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 14 KB)
15010_2018_1236_MOESM2_ESM.docx (31 kb)
Supplementary material 2 (DOCX 30 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Trauma and OrthopaedicsNottingham City HospitalNottinghamUK
  2. 2.The Pulvertaft Hand Surgery UnitRoyal Derby HospitalDerbyUK

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