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Septic Tenosynovitis of the Hand: Factors Predicting Need for Subsequent Débridement.
- Source :
-
Plastic and reconstructive surgery [Plast Reconstr Surg] 2015 Sep; Vol. 136 (3), pp. 338e-343e. - Publication Year :
- 2015
-
Abstract
- Background: Treatment of septic hand tenosynovitis is complex, and often requires multiple débridements and prolonged antibiotic therapy. The authors undertook this study to identify factors that might be associated with the need for subsequent débridement (after the initial one) because of persistence or secondary worsening of infection.<br />Methods: In this retrospective single-center study, the authors included all adult patients who presented to their emergency department from 2007 to 2010 with septic tenosynovitis of the hand.<br />Results: The authors identified 126 adult patients (55 men; median age, 45 years), nine of whom were immunosuppressed. All had community-acquired infection; 34 (27 percent) had a subcutaneous abscess and eight (6 percent) were febrile. All underwent at least one surgical débridement and had concomitant antibiotic therapy (median, 15 days; range, 7 to 82 days). At least one additional surgical intervention was required in 18 cases (median, 1.13 interventions; range, one to five interventions). All but four episodes (97 percent) were cured of infection on the first attempt after a median follow-up of 27 months. By multivariate analysis, only two factors were significantly associated with the outcome "subsequent surgical débridement": abscess (OR, 4.6; 95 percent CI, 1.5 to 14.0) and longer duration of antibiotic therapy (OR, 1.2; 95 percent CI, 1.1 to 1.2).<br />Conclusion: In septic tenosynovitis of the hand, the only presenting factor that was statistically predictive of an increased risk of needing a second débridement was the presence of a subcutaneous abscess.<br />Clinical Question/level of Evidence: Risk, III.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents therapeutic use
Combined Modality Therapy
Female
Humans
Male
Middle Aged
Pasteurella Infections diagnosis
Pasteurella Infections drug therapy
Reoperation
Retrospective Studies
Staphylococcal Infections diagnosis
Staphylococcal Infections drug therapy
Streptococcal Infections diagnosis
Streptococcal Infections drug therapy
Tenosynovitis diagnosis
Tenosynovitis drug therapy
Treatment Outcome
Young Adult
Debridement
Pasteurella Infections surgery
Pasteurella multocida isolation & purification
Staphylococcal Infections surgery
Streptococcal Infections surgery
Streptococcus pyogenes isolation & purification
Tenosynovitis surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1529-4242
- Volume :
- 136
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Plastic and reconstructive surgery
- Publication Type :
- Academic Journal
- Accession number :
- 26313838
- Full Text :
- https://doi.org/10.1097/PRS.0000000000001510