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

Abstract

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. 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. 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 24h. 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. 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.