The Usefulness of Performing Extensive Debridement to Prevent Infections in Open Flexor Tendon Injuries of the Hand

Leo Daniel D. Caro, Ernesto Carlo B. Arada and Nathaniel S. Orillaza Jr.

Department of Orthopedics, College of Medicine and
Philippine General Hospital, University of the Philippines Manila

Background. Infection after flexor tendon repair in the hand is uncommon but may cause debilitating problems if not prevented. In centers where delayed presentation after injury happens often, early bacterial colonization is assumed and an initial debridement is indicated ensuring a clean environment for subsequent repair. Preference for the type of initial debridement differ from surgeon to surgeon.

Objective. This paper aims to compare limited and extensive initial debridement in preventing post-operative infection in patients treated more than 24 hours after open tendon injury.

Methods. A retrospective review of records for demographics, the type of debridement and occurrence of infection was performed. Statistical comparison of proportions of post-operative infection was done.

Results. Of thirty-one records included, twenty-four patients underwent extensive debridement while 7 had limited. Two patients from each group developed infections resulting to 8.3 % infection in the extensive group and 28.6 % in the limited group. The difference is not statistically significant.

Conclusion. The trend for a higher infection rate in the limited group supports the need for aggressive debridement in managing delayed presenting patients with open tendon injuries. While the non-significant difference potentially supports the less cumbersome option, a better powered study is recommended to confirm.

Key Words: tendon transection, debridement, infection