- Technique: - goal is to establish closed continuous drainage thru flexor sheath; - tourniquet should be used; - incision & drainage of flexor tendon sheaths are performed from both proximal and distal ends; -
palmar incision: - transverse incision is made just proximal to distal palmar crease, over the infected tendon; - spread thru the palmar aponeurosis; - make incision just proximal to A1 pully and enter into sheath; -
distal incision: - finger incision may be made either dorslateral at level of middle phalanx or directly on palmar surface at this level; - incision can also be made in the distal flexor crease of digit; - distal sheath is exposed thru ulnar midaxial incision & opened; - enter sheath between annular pulleys, insert small catheter (size no. 5 Fr) -
evaluation of flexor tendons: - flexor tendon may have to be excised; - after the infection has been eradicated and the wound closed, consider
free tendon grafting and staged tendon reconstruction; -
rebuild pulleys at the time of prosthesis insertion; -
irrigation: - thread a soft catheter (No. 5 pediatric feeding tube) into distal incision; - alternatively, 16 ga. polyethylene catheter is inserted into sheath; - drain is brought out thru skin and the skin is loosely sutured; - irrigate w/ either sterile saline or sterile Ringer lactate solution; - sheath is irrigated with 25 to 50 ml of saline/hour; - antibiotics are not added to the fluid, since this might invite an additional inflammatory reaction in the sheath; - dressing should contain fluffed gauze and ADB pads to absorb fluid; - dressing is changed as needed;
