SUPPURATIVE FLEXOR TENOSYNOVITIS LEADING TO ISCHAEMIC DIGITAL NECROSIS AND AMPUTATION – A CASE REPORT

Suppurative Flexor Tenosynovitis of the hand is a rapid spreading condition with significant morbidity effect on hand function. The avascular nature of the tendon sheath has its disadvantage of limiting the host immune system response towards bacterial invasion and proliferation. Immunosuppression from conditions like diabetes predisposes the occurrence of the condition. A 39 year old housewife presented with signs and symptoms of left middle finger flexor tenosynovitis with distal wet gangrene. Extensive drainage and amputation of the gangrenous digit was done, with subsequent healing albeit minimal residual functional impairment. The case highlights the importance of early detection and appropriate referral of flexor tenosynovitis cases so that early aggressive intravenous antibiotics and surgical debridement and irrigation can be performed to avoid the preventable complication of digital necrosis and subsequently amputation. Literature review was done to explain the pathophysiology, determine the poor prognostic factors and outcome of this condition.