Flexor Sheath Infection

***Must inform registrar and/or consultant on-call***

introduction (1,2)

Surgical emergency
Delayed treatment may lead to extension of infection into the hand and forearm with severe sepsis and permanent flexor injury

Image Reference: Orthobullet's "Pyogenic Flexor Tenosynovitis" Article. (2019)

Assessment (2)

History

Examination

Kanavel’s four cardinal sings (3) (patients may have 1 or all 4):

management (1,4)

NBM
IV Abx (consult local guidelines)
Pain relief
Immobilisation
Strict elevation in Bradford sling
Arrange urgent senior review

Early infection may respond to ‘closed drainage’ with small palmar and digital incisions in theatre to allow catheter insertion.

references

1. Chiu TW. Stone’s Plastic Surgery Facts: A Revision Guide, Fourth Edition. CRC Press; 2018. 2. Green DP, Wolfe SW. Green’s operative hand surgery. Elsevier/Churchill Livingstone; 2011. 3. Kennedy CD, Huang JI, Hanel DP. In Brief: Kanavel’s Signs and Pyogenic Flexor Tenosynovitis. Clin Orthop Relat Res. 2016 Jan;474(1):280–4. 4. Mamane W, Lippmann S, Israel D, Ramdhian-Wihlm R, Temam M, Mas V, et al. Infectious flexor hand tenosynovitis: State of knowledge. A study of 120 cases. J Orthop. 2018 Jun;15(2):701–6.
Image References:Header Image Reference: Licensed by Adobe Stock (2019)Digital Flexor Sheath Infection Image Reference: Orthobullet's "Pyogenic Flexor Tenosynovitis" Article. (2019)

This subpage has been reviewed by:
1) Mr. Martin Shapev - Plastic Surgery Registrar, RD&E (06/02/2020)