Abstract Journal Hand Surgery

Abstract

Journal Hand Surgery HS001 NON-OPERATIVE MANAGEMENT OF ACUTE INFECTIOUS FLEXOR TENOSYNOVITIS: A REVIEW OF THE LITERATURE SIBON FUZZARD, CONOR MORRIS, VICKY TOBIN, WARREN ROZEN AND DAVID HUNTER-SMITH Peninsula Health, VIC Background: Infectious flexor tenosynovitis is a bacterial infection of the flexor tendon sheath which can spread aggressively and result in severe functional limitation. Traditional teaching dictated emergent surgical exploration to widely open and irrigate the tendon sheath. The most recent review on management in 2015 has somewhat shifted this convention, supporting the use of limited surgical approaches alongside systemic antibiotic therapy. Objective: To appraise the available and emerging literature on the nonoperative management of infective flexor tenosynovitis. Method: A literature review of the management and outcomes of patients with acute infectious flexor tenosynovitis was carried out. Twenty-four studies were included, all of which were observational. Details of patient characteristics, management strategies and outcome measures were extracted. Results: Outcome measures were reported inconsistently across the available studies. The most consistently reported outcome was duration of hospitalisation, which was reduced with antibiotic therapy alone (4.7 days vs 9.3 days). In the only dual-armed study reporting functional outcomes, there was limited evidence to support improved outcomes in non-operative patients. Conclusion: Given the lack of high-quality literature on this topic and the heterogeneity of reporting, strong recommendations about the role of nonoperative management for infectious flexor tenosynovitis cannot be made at this time. A prospective, controlled trial would be required to provide further conclusions. This review sheds light on a condition that we should endeavour to research further so it can be managed in an evidence-based way, despite the temptation to continue to practice management steeped in