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Effectiveness of Operative versus Bedside Incision and Drainage for Flexor Tenosynovitis
G. Zehra Kocyigit
*, Nirbhay Jain, Lenny Rivera-Rosario, Joseph Banuelos, Erik Reiche, Dana E. Bregman
Plastic Surgery, University of Pittsburgh, Pittsburgh, PA
Background: Flexor tenosynovitis (FTS) is traditionally managed with incision and drainage (I&D) in the operating room (OR), though performing minor procedures outside the main OR may improve efficiency without compromising outcomes. Evidence comparing bedside versus OR I&D for FTS remains limited. This study aimed to compare clinical and functional outcomes between bedside and OR I&D performed in a single academic hand surgery practice.
Methods: A retrospective review was conducted of 165 consecutive patients who underwent I&D for FTS between June 2019 and September 2026. Cases were categorized by I&D location (bedside vs OR). Of these, 89 patients had one-month follow-up and were included in the analysis. Demographics, comorbidities, Kanavel signs, and surgical site were recorded. Primary outcomes included readmission for recurrent symptoms, ability to make a fist, need for repeat I&D, and amputation rate. Secondary outcomes included length of stay and need for additional outpatient treatment.
Results: Of 89 patients, 36 underwent bedside I&D and 53 underwent OR I&D. In the OR group, 70% underwent additional procedures beyond flexor tenosynovitis washout. Bedside I&D was associated with a higher rate of full fist closure at follow-up (55.6% vs 30.2%), whereas partial fist recovery was more common after OR treatment (67.9% vs 36.1%). Among patients initially requiring bedside drainage, 33% needed a second washout, although this decreased to 16% over time. Length of stay, delayed amputation, and readmission did not differ significantly.
Conclusion: Bedside I&D demonstrated safety comparable to OR-based procedures, with equivalent hospital stay, amputation, and readmission rates. Although bedside I&D achieved better functional recovery, it was associated with higher reoperation rates. These findings support bedside I&D as a viable first-line approach for carefully selected FTS patients, provided close follow-up and prompt escalation to operative management when indicated.
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