Flexor tendon phlegmons (infectious flexor tenosynovitis) – Aftercare regimen

Aftercare regimen following surgery on an infectious flexor tenosynovitis

Is an immobilization required after surgery?

Yes. After each surgery on flexor tendon phlegmons, immobilization is mandatory until the infection recedes. A temporary immobilization also serves the purpose of pain reduction. Frequent dressing changes, however, are required in order to identify potential new infectious flare ups on time.

Cast immobilization on a hand which was treated for a flexor tendon phlegmon.

Cast immobilization as part of the aftercare therapy following a treated hand infection.

The image shows a cast immobilization after surgery on a flexor tendon phlegmon in the thumb. Please note how all of the not concerned fingers are kept mobile.

What has to be done in case the infection is not healing?

In this case it is advisable to commit to a second or even third surgical procedure, in order to remove further semi-necrotic or necrotic tissue which may form after the first procedure. Such newly emerged, nonviable tissue structures are point of origin for new flare ups of the infection. It is better to commit to a second or even third surgical procedure rather than to wait an inadequate amount of time while risking a new severe infection.

Challenges of the aftercare therapy following surgery on an infectious flexor tenosynovitis

What else requires special attention in connection with the aftercare regimen?

One of the most frequent challenges of the aftercare regimen appears to be mobility malfunctions due to extensive immobilization. A very helpful measure in the fight against severe mobility malfunctions is the early involvement of physiotherapeutic exercises. A combination with ergo therapeutic measures may also be advisable to prevent serious mobility dysfunctions associated with this condition.

What can be done when severe mobility malfunctions continue to persist even after completion of physiotherapeutic or ergo therapeutic measures?

It is possible to take corrective actions at a later time. The adhesions may be separated. This however should only be considered once the healing soft tissue is sufficiently restored.

All secondary interventions geared towards the improvement of mobility should only be considered several months after the infection healed, to allow for the required scar maturity and alleviation to take place.

Prior to consider further surgery all potential benefits available through physiotherapy should be utilized!

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