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Flexor tendon sheath Irrigation and debridement 26020

 
CPT Technique
Indications Complications
Contraindications Follow-up Care / Rehab Protocol
Alternatives Outcomes
Pre-op Planning / Case Card Review References

synonyms:

 Flexor tendon sheath Irrigation and debridement  CPT

Flexor tendon sheath Irrigation and debridement  Indications

  • Septic tenosynovitis, finger, flexor sheath. 

 Flexor tendon sheath Irrigation and debridement  Contraindications

  •  

Flexor tendon sheath Irrigation and debridement  Alternatives

  • Trial of IV antibiotics (if infection caught early or diagnosis uncertain)

Flexor tendon sheath Irrigation and debridement  Pre-op Planning

  • Ensure 18-gauge angio caths are available

Flexor tendon sheath Irrigation and debridement  Technique

  • Sign operative site.
  • Supine position.
  • Transverse incision at the level of the proximal end of the metacarpal in the distal palmar flexion crease. 
  • Blunt dissection to the flexor sheath preserving the neuromuscular bundles. 
  • Incise the  sheath  longitudinally proximal to the A1 pulley. 
  • Culture
  • Insert 18 gauge angio cath  under the A1 pulley.
  • Second transverse incision (or Bunnel incision) over DIP flexion crease.
  • Incise flexor sheath  longitudinally, just distal to the A4 pulley.
  • Irrigate through the 18 gauge angio cath proximally.
  • Consider  second 18 gauge angio cath placed in the flexor sheath distally. 
  • Gentle irrigation with normal saline through the proximal incision should flow out the distal wound.
  • Consider leaving angio caths  in place and irrigating sheath with normal saline every other hour for 24-48hours. 
  • Incision are left open and not repaired with suture.
  • A light dressing applied.

Flexor tendon sheath Irrigation and debridement  Complications

Flexor tendon sheath Irrigation and debridement  Follow-up care

  • Post-op:
  • 7-10 Days:
  • 3 Weeks:
  • 6 Weeks:
  • 2 Months:
  • 3 Months:
  • 6 Months:
  • 1Yr:

Flexor tendon sheath Irrigation and debridement  Outcomes

Flexor tendon sheath Irrigation and debridement  Review References