Hand infection drainage

# OPERATION NOTE — Hand infection drainage

Date: 19/05/2026Acute
Surgeon: Mateusz Gładysz, Consultant Plastic and Hand Surgeon
Assistant: [Registrar Dr ____]
Anaesthetist: [Dr ____]    Anaesthetic: GA
WHO Surgical Safety Checklist: Sign-in / Time-out / Sign-out — completed.

## Diagnosis / Indication

- Pyogenic flexor tenosynovitis of [DIGIT] — Kanavel signs ([___]/4) positive; symptom duration [___] days.
- Inflammatory markers: WCC [___], CRP [___]. Empirical flucloxacillin started in ED.

## Consent

Risks: stiffness, tendon adhesion / rupture, amputation (severe cases), recurrence requiring further washout, sensory or motor deficit, CRPS, scar.

## Position / Anaesthesia / Tourniquet

Supine, arm on hand table. GA. Exsanguinate by elevation (Esmarch avoided in infection); upper arm tourniquet 250 mmHg.

## Antibiotics

Empirical antibiotics held until intra-operative cultures taken, then resumed.

## Procedure — Pyogenic flexor tenosynovitis

1. Bruner zig-zag distal incision over A5 pulley AND proximal transverse incision over A1 pulley.
2. Sheath opened at both ends; turbid fluid sampled for MC&S, Gram stain, fungal / AFB.
3. 16G angiocatheter inserted antegrade through A1 sheath; sheath irrigated with 1 L warmed normal saline until effluent runs clear.
4. Michon stage assessed: II (purulent).
5. Distal incision left open with small drain (16G angiocath) sutured at A5; proximal closed loosely with 5-0 nylon.
6. Tourniquet down; final lavage; haemostasis.
7. Volar splint applied; hand elevated.

## Findings

- Michon stage II tenosynovitis; sheath intact; tendon viable.

## Estimated blood loss

<10 mL.

## Complications

Nil intra-operative.

## Count

Swabs / needles / instruments — confirmed correct.

## Post-op plan

- Admit; IV antibiotics per Microbiology (commonly flucloxacillin 2 g qid; vancomycin if MRSA risk; tazocin if Pasteurella / bite mechanism).
- Re-look in theatre at 24–48 h if Michon III or ongoing sepsis.
- Hand therapy referral once infection controlled.
- Daily ward review; CRP / WCC trend.
- ACC claim lodged if penetrating mechanism.

## Signature

Mateusz Gładysz, Consultant Plastic and Hand Surgeon — 19/05/2026