The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Hand (N Y). 2023 Mar;18(2):320-327. doi: 10.1177/1558944721999729. Epub 2021 Apr 21.
Pyogenic flexor tenosynovitis (PFT) has been considered a surgical emergency. Varying operative approaches have been described, but there are limited data on the method, safety, and efficacy of nonoperative or bedside management. We present a case series where patients with early flexor tenosynovitis are managed using a limited flexor sheath incision and drainage (I&D) in the emergency department (ED) to both confirm purulence within the flexor sheath and as definitive treatment.
A retrospective study of all patients clinically diagnosed in the ED with flexor tenosynovitis at our institution from 2012 to 2019 was performed. Patients with frank purulence on examination were taken emergently to the operating room (OR). Patients with equivocal findings underwent limited flexor sheath I&D in the ED. Safety and efficacy were studied for patients with early flexor tenosynovitis managed with this treatment approach.
Thirty-four patients met the inclusion criteria. Ten patients underwent direct OR I&D, and 24 patients underwent ED I&D. In the ED I&D group, 96% (24 of 25) of patients did not have frank purulence in the flexor sheath and were managed with bedside drainage alone. There were no procedural complications and no need for repeat operative intervention. Time to intervention (3.1 hours vs 8.4 hours) was significantly shorter for the ED I&D group compared with the OR I&D group. Within the ED I&D group, 86% of patients exhibited good/excellent functional scores.
Limited flexor sheath I&D in the ED provides a potential safe and effective way to manage patients with early flexor tenosynovitis.
脓性屈肌腱腱鞘炎 (PFT) 被认为是一种紧急手术。已经描述了不同的手术方法，但关于非手术或床边管理的方法、安全性和疗效的数据有限。我们提出了一系列病例，这些病例中的早期屈肌腱腱鞘炎患者在急诊科通过有限的屈肌腱鞘切开引流 (I&D) 进行治疗，以确认屈肌腱鞘内的脓液，并作为明确的治疗方法。
对 2012 年至 2019 年期间在我院急诊科临床诊断为屈肌腱腱鞘炎的所有患者进行回顾性研究。体格检查有明显脓液的患者紧急送往手术室 (OR)。检查结果不确定的患者在急诊科行有限的屈肌腱鞘 I&D。研究了通过这种治疗方法治疗早期屈肌腱腱鞘炎的患者的安全性和疗效。
34 名患者符合纳入标准。10 名患者接受直接 OR I&D，24 名患者接受 ED I&D。在 ED I&D 组中，96%（24/25）的患者在屈肌腱鞘内没有明显脓液，仅通过床边引流即可治疗。没有手术并发症，也不需要再次手术干预。与 OR I&D 组相比，ED I&D 组的干预时间（3.1 小时对 8.4 小时）明显缩短。在 ED I&D 组中，86%的患者表现出良好/优秀的功能评分。
ED 中的有限屈肌腱鞘 I&D 为治疗早期屈肌腱腱鞘炎患者提供了一种潜在的安全有效的方法。
