Factors associated to amputation in pyogenic flexor tenosynovitis in a tertiary referral center in Mexico

Abstract

Background: Pyogenic flexor tenosynovitis is an aggressive closed-space infection, which affects the flexor tendon sheath of the hand with disabling sequelae. The purpose of this study is to describe the patient demographic characteristics and identify factors associated with amputation in pyogenic flexor tenosynovitis. Methods: In this retrospective single-center study, included all adult patients who presented to the emergency department from 2015 to 2021 with PFT of the hand. Descriptive summary statistics were reported on patient demographics, presenting symptoms and clinical examination features, culture results, treatment strategies, and early complications. The factors influencing amputation were identified and analyzed. Results: A total of 59 patients with PFT diagnosis were included. Most of the population was found to be immunosuppressed (34 patients). Moreover, the most common comorbidities were the combination of diabetes mellitus and systemic arterial hypertension. The third right finger was the most frequently affected region. Almost all patients were hospitalized, intravenous antibiotics, and at least one additional surgical intervention was required in 16 cases. Amputation of the infected finger occurred in 6 patients, associated with different factors: reintervention, age over forty, presence of diabetes mellitus and chronic arterial hypertension, penetrating trauma, and presence of Enterococcus faecalis in culture. Conclusions: Rapid and aggressive treatment is required to prevent devastating complications such as amputation. Adequate identification of the disease and risk factors is critical for a successful result. E. faecalis represents the most common pathogen in this study, unlike the reported literature. Thus, broad-spectrum antibiotics and surgical intervention are required.