Surgical washout of the flexor sheath for pyogenic flexor tenosynovitis can be done using either an open approach (with lateral mid-axial or Bruner-type incisions) or by closed catheter irrigation (CCI). The latter is used in many units and has been shown in a retrospective study to yield equivalent early results to the open approach, but with the advantage of smaller incisions (Gutowski et al., 2002). There is thus potentially less risk of stiffness, scarring, and flap necrosis. There are several variations of the CCI technique, but most use an incision in the palm to expose the flexor sheath just proximal to the A1 pulley and a distal incision for outflow of irrigation fluid. Various irrigation catheters have been used, including intravenous cannulae, angi-ocatheters, ureteric catheters, and paediatric feeding tubes (Gutowski, 2008).
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