Closed Continuous Irrigation as a Treatment for Infection in the Hand

A method of closed irrigation has been devised to treat infections in the hand. After adequate débridement, two tubes are placed in the infected area, an inlet tube and an outlet tube. For a small infection, one tube serves both purposes. The wound is closed completely. Irrigation with saline and antibiotic solution is continued for 1 week, extended up to 3 weeks in cases of severe infection. This method has been applied in 31 cases including pyogenic tenosynovitis, tuberculous tenosynovitis, pyogenic arthritis, osteomyelitis, bite injury, crush injury and amputation stump infection. Infection healed primarily in 29 cases. Further surgery was needed in two cases which healed finally.

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Closed Continuous Irrigation in the Treatment of Hand Infections

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.1998.0009 ◽

1999 ◽

Vol 24 (3) ◽

pp. 328-333 ◽

Cited By ~ 22

Author(s):

P. A. HARRIS ◽

J. NANCHAHAL

Keyword(s):

Septic Arthritis ◽

Functional Recovery ◽

Irrigation System ◽

Surgical Debridement ◽

Hand Therapy ◽

Continuous Irrigation ◽

Outlet Tube ◽

Inlet Tube ◽

Flexor Tenosynovitis

We report our experience with a closed continuous irrigation system in 12 patients with hand infections: six cases of flexor tenosynovitis, three cases of septic arthritis and three palmar abscesses. Four of these patients had undergone previous surgical débridement and peroperative washout without elimination of the infection. The continuous irrigation system consists of two fenestrated tubes placed within the infected space, with the tip of the smaller calibre inlet tube positioned just inside the larger outlet tube. Resolution of infection was achieved in all 12 cases and all regained complete functional recovery. The closed continuous irrigation system is easy to manage, with no leakage of fluid; hand therapy may be started early and the patient is mobile throughout.

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Semi-Ebonite. Part 2

Rubber Chemistry and Technology ◽

10.5254/1.3539758 ◽

1936 ◽

Vol 9 (3) ◽

pp. 468-485

Author(s):

P. A. Gibbons ◽

F. H. Cotton

Keyword(s):

Experimental Method ◽

Original Form ◽

Considerable Difficulty ◽

Outlet Tube ◽

Test Pieces ◽

Volatile Products ◽

Inlet Tube ◽

Frequent Reference ◽

Conical Flask

Abstract In Part 1 (Rubber Chem. and Tech., 8, 554 (1935)) frequent reference was made to the volatile products emitted during the aging of semi-ebonite under different conditions. In this section an experiment is described wherein the various products were detected and some attempt made to estimate the relative amounts of each. The experiment in its original form presented considerable difficulty, and many disappointments were experienced before a modified apparatus was finally adopted. Experimental Method.—Eight test-pieces, one from each of the accelerated cures (see Part 1), were cut to a convenient size, six inches by one inch. The test-pieces were carefully weighed and their thickness determined as the average of several readings on the micrometer. The strips were suspended from a bent glass rod projecting from a cork-bearing inlet and outlet tubes (see Fig. 5). The cork was then inserted in a clean conical flask and the latter sealed with wax until it withstood a considerable vacuum. The flask was placed in a Geer oven automatically maintained at 70° C. The outlet tube was attached to an absorption train and the inlet tube to a purifying train.

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Continuous irrigation of povidone-iodine and antibiotic solution in infected prosthetic graft.

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.15.410 ◽

1986 ◽

Vol 15 (4) ◽

pp. 410-411

Author(s):

H. Hagiwara

Keyword(s):

Povidone Iodine ◽

Prosthetic Graft ◽

Continuous Irrigation ◽

Antibiotic Solution

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Experience with arthroscopic debridement and continuous irrigation in the treatment of pyogenic arthritis of the shoulder.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.38.209 ◽

1989 ◽

Vol 38 (1) ◽

pp. 209-212

Author(s):

Kazuhiko Imai ◽

Mitsuru Takeshita ◽

Masafumi Hara ◽

Koji Midorikawa ◽

Shogo Tamura ◽

...

Keyword(s):

Arthroscopic Debridement ◽

Continuous Irrigation ◽

Pyogenic Arthritis

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Tuberculous Tenosynovitis of the Hand

Hand Surgery ◽

10.1142/s0218810497000276 ◽

1997 ◽

Vol 02 (02) ◽

pp. 157-161

Author(s):

Koichi Nemoto ◽

Yoshiyasu Itoh ◽

Yasuyuki Hamano ◽

Noriyuki Kimura

Keyword(s):

Early Diagnosis ◽

Hand Function ◽

Surgical Debridement ◽

Postoperative Chemotherapy ◽

Diagnosis And Treatment ◽

Tissue Destruction ◽

Continuous Irrigation ◽

Dorsal Aspect ◽

Tuberculous Tenosynovitis ◽

Palmar Aspect

Nine cases of tuberculous tenosynovitis of the hand were reviewed. The infected sites were the palmar aspect in eight cases and the dorsal aspect in one. In all cases, surgical debridement and thorough synovectomy were performed and postoperative chemotherapy was given. Closed continuous irrigation was performed in four cases. Though recurrence occurred in 5 cases, all patients healed eventually. Final hand function was related to the degree of preoperative tissue destruction. Pathologic changes of tuberculosis were confirmed in all cases; however, the tuberculous bacillus was detected in only four cases. Early diagnosis and treatment are essential in the management of the disease.

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Debridement and Continuous Irrigation for the Treatment of Pyogenic Arthritis Caused by the Use of Intra-Articular Injection in the Osteoarthritic Knee: Indications and Outcomes

Journal of Orthopaedic Surgery ◽

10.1177/230949900501300109 ◽

2005 ◽

Vol 13 (1) ◽

pp. 52-57 ◽

Cited By ~ 8

Author(s):

H Tsumura ◽

S Ikeda ◽

T Torisu

Keyword(s):

Weight Bearing ◽

Treatment Options ◽

Japanese Orthopaedic Association ◽

Joint Destruction ◽

Double Lumen Tube ◽

Osteoarthritis Of The Knee ◽

Continuous Irrigation ◽

Tibial Resection ◽

Pyogenic Arthritis ◽

Femorotibial Joint

Purpose. To discuss the indications and therapeutic outcomes of synovectomy, debridement, and continuous irrigation for the treatment of pyogenic arthritis caused by intra-articular injection used in the treatment of osteoarthritis of the knee. Methods. Records of 41 patients with infectious arthritis of the knee who presented to our hospital from 1981 were reviewed. 11 of them had a history of intra-articular injection. They underwent synovectomy, debridement, and continuous irrigation using a Salem double-lumen tube after confirmation that one side of the femorotibial joint cartilage was basically healthy. Results. The infection was successfully treated in 9 of the 11 patients. Of these 9 patients, one died after 3 years and 2 underwent total knee arthroplasty after 3 and 8 years. The remaining 6 patients were followed up for 5 to 15 years. Five of them had deteriorating arthropathy, and the condition was unchanged in the others. Two of these 6 patients had pain while walking, and their Japanese Orthopaedic Association scores were 70. The remaining 4 had good knee function and reduction of pain, with a mean Japanese Orthopaedic Association score of 91 and a mean range of motion of 131 degrees. Conclusion. Arthrodesis is frequently considered the treatment for osteoarthritis if the joint destruction has affected the weight-bearing surface. However, in our experience, even when inflammatory granulation develops in the cartilage surface of one side of the femorotibial joint, good results can still be obtained by synovectomy, debridement, and continuous irrigation. After the pyogenic arthritis has subsided, if osteoarthritis has advanced and bowleg has exacerbated, further treatment options are available, such as tibial resection and even joint replacement. Continuous irrigation should be considered a feasible treatment option for pyogenic arthritis.

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Fibrinolysis and Coagulation in Patients with Infectious Disease and Sepsis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648137 ◽

1991 ◽

Vol 65 (03) ◽

pp. 291-295 ◽

Cited By ~ 47

Author(s):

J Philippé ◽

F Offner ◽

P J Declerck ◽

G Leroux-Roels ◽

D Vogelaers ◽

...

Keyword(s):

Infectious Disease ◽

Plasminogen Activator ◽

Protein C ◽

Severe Infection ◽

Plasminogen Activator Inhibitor ◽

Tissue Type ◽

Type Plasminogen Activator ◽

Significant Difference ◽

At Iii ◽

C 30

SummarySepsis is often associated with hemostatic dysfunction. This study aimed to relate changes in fibrinolysis and coagulation parameters to sepsis and sepsis outcome. Urokinase-type plasminogen activator (u-PA) antigen, tissue-type plasminogen activator (t-PA) antigen and activity, plasminogen activator inhibitor (PAI) type 1 antigen, PAI activity, antithrombin (AT) III activity, and protein C activity were measured in 24 patients suffering from sepsis or septic shock and the results were compared with those observed in 30 non-sepsis patients with severe infectious disease. The u-PA level was markedly increased in plasma of sepsis patients as compared to non-sepsis patients (11.5 ± 9.4 versus 1.6 ± 1.5 ng/ml, p <0.0001). PAI-1 antigen and t-PA activity showed a significant increase in sepsis patients (320 ± 390 ng/ml versus 120 ± 200 ng/ml, and 3.0 ± 3.6 IU/ml versus 1.0 ± 0.7 IU/ml, respectively, p <0.01). AT III was decreased in sepsis patients (58 ± 28% in sepsis versus 79 ± 26% in severe infectious disease, p <0.01) as was protein C (30 ± 18% versus 58 ± 27%, p <0.001). No significant difference was found for t-PA antigen nor for PAI activity. Nonsurvivors of sepsis were distinguished mainly by a high u-PA antigen level and increased t-PA activity. It is concluded that plasma u-PA antigen showed the strongest significant difference, among the parameters evaluated, between sepsis and severe infection. u-PA antigen may be of prognostic value in patients admitted to the medical intensive care unit for severe infectious disease.

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