tailieunhanh - Hand and Wrist Surgery - part 2

52-năm-insulin-người đàn ông mắc bệnh tiểu đường phụ thuộc vào trình bày cho bác sĩ chăm sóc chính mình 4 ngày sau khi duy trì một vết thương đâm lòng bàn tay trong khi mài một con dao. Do sưng và ban đỏ về vết thương nằm phía trên các khía cạnh lòng bàn tay của các doanh metacarpophalangeal thứ tư | INFECTIONS PEARLS Early diagnosis followed by early antibiotic and surgical intervention Adequate drainage ofinfec-tion Appropriate antibiotic management based on cultures PITFALLS Necrotic tissue removal necessary Complications result from inadequate drainage of infection 8 Supporative Flexor Tenosynovitis John C. P. Floyd and Waldo E. Floyd III History and Clinical Presentation A 52-year-old insulin-dependent diabetic man presented to his primary care physician 4 days after sustaining a palmar stab wound while sharpening a knife. Due to swelling and erythema about the wound overlying the palmar aspect of the fourth metacarpophalangeal joint the patient was admitted to the hospital and placed on parenteral cefazolin. Significant medical history included insulindependent diabetes mellitus peripheral vascular disease and coronary artery disease. Bilateral above the knee amputations multiple coronary artery bypass grafts complicated by wound healing problems and drug allergies to vancomycin sulfa doxycycline clindamycin and ceftazidime characterized his medical history. The patient had undergone a limited incision and drainage procedure by an orthopedic surgeon in the palmar wound just proximal to the A-1 pulley. The flexor tendons were reported to have been intact. Purulent fluid had been expressed from a rent in the flexor tendon sheath. The sheath was further incised and irrigated through a pediatric feeding tube. Purulent material was obtained for cultures and sensitivities. Despite oral amoxicillin management purulent drainage and erythema persisted prompting hand surgery referral. Physical Examination On presentation to the hand surgeon the palmar wound was draining serous fluid and there was no flexor tendon function Fig. 8 1 . Flexor tendons were visible within the wound with a significant amount of surrounding nonviable tissue. Further surgical intervention was deemed appropriate. .