Phlegmon of the flexor tendons

What is flexor tendon phlegmon?

It’s an infection that develops around the tendons that flex the fingers. These tendons are wrapped in a closed sheath so that they can glide smoothly. On the other hand, this sheath is an excellent medium for the proliferation of bacteria. Infection most often develops following a wound, but can also occur without any known accident. If left untreated, infection can spread to other fingers, weakening tendons. Although rare, the possibility of generalized infection exists.

Within a few hours or days, the finger swells and pain appears throughout the finger and into the palm. It becomes very difficult to fold or extend it, even with the help of the other hand. Rarely, there may be a slight fever.

What tests are required?

In general, a clinical examination by the doctor is sufficient to make the diagnosis. An X-ray is sometimes performed to rule out the presence of a foreign body following a wound. Ultrasound can also be performed to show the presence of infection and identify a foreign body.

How is flexor tendon phlegmon treated?

Phlegmon treatment is surgical, as antibiotics alone are not sufficiently effective.

As this is an infection in a closed space, the first thing to do is to evacuate the infection by opening the flexor tendon sheath and flushing it out. If necessary, it may be necessary to intervene on several fingers or on the wrist. After surgery, a cast is applied for a few days to reduce pain and inflammation. A course of antibiotics may be started after the operation, lasting one to two weeks. Depending on the severity of the infection, it may be necessary to perform the procedure in a hospital or clinic, so that you can be hospitalized for monitoring and receive antibiotics through the vein. Further surgery to flush out infected areas is sometimes necessary.

Rehabilitation sessions are often necessary to combat stiff fingers. Time off work lasts from two to six weeks, depending on the profession and the severity of the infection. Sports activities should be interrupted for a similar length of time.

What are the possible complications?

Common to all surgeries

Infection of the wound may occur, but is usually cured by local care and the prescription of antibiotics. Surgical drainage is rare.

Hematoma corresponds to an accumulation of blood under the skin. It’s not a problem if it’s small, but if it’s larger, surgical evacuation may be necessary.

Healing problems (delayed healing, thick scars) occur more frequently in patients who smoke.

Inadvertent injury to an artery, nerve, ligament or tendon is always possible, although rare. These structures can be repaired, but recovery may be prolonged or even incomplete.

Chronic regional pain syndrome is a disproportionate inflammatory reaction of the body following surgery. It causes pain, swelling and stiffness, requiring treatment that can last several months.

Complications specific to phlegmon

Stiffness of the fingers is common, and is usually transient thanks to occupational therapy. In severe cases, where several fingers have been affected by the infection, some degree of stiffness may persist permanently.

One or more tendons may rupture if they have been weakened by the infection. A new intervention is then required if the lost function is to be recovered.