[Closed irrigation system for pyogenic flexor tenosynovitis of the hand].

OBJECTIVE

Treatment of pyogenic flexor tenosynovitis within the osteofibrous channel of the thumb and finger by insertion of a closed irrigation system.

INDICATIONS

Pyogenic tenosynovitis of the flexor tendons of the hand.

CONTRAINDICATIONS

Necrosis of the flexor tendons or flexor tendon sheath, gangrene of the finger, extensive loss of soft tissue.

SURGICAL TECHNIQUE

Insertion of a flexible irrigation catheter via a guide wire into the flexor tendon sheath and a vacuum suction drain into the finger or the palm of the hand. Extensive exploration of the flexor tendon sheath is not mandatory.

POSTOPERATIVE MANAGEMENT

On days 0-3 continuous irrigation, on day 4 change of the irrigation catheter to suction, on day 5 removal of the irrigation catheter, on day 6 removal of the suction drain, on day 7 start of exercise. Irrigation volume: about 500-1500 ml/24 h isotonic solution.

RESULTS

Of 35 patients treated for flexor tenosynovitis by closed irrigation, 33 were reviewed. There were 19 male patients and 14 female patients. The average age at the time of surgery was 51 (8-85) years. Hospital stay was 8.9 (3-26) days on average. At the time of follow-up, the average grip strength was 84% (23-163%) of the unaffected side. Pain at rest was 0.2 (0-4), pain during exercise 1.2 (0-8) on the analogue scale, the DASH score was 16.8 (0-58) points. According to the rating system for flexor tendon function, there were one poor, one fair, five good, and 26 excellent results.