Phlegmons of the Hand: Epidemiological, Clinical, Therapeutic, and Prognostic Study of 45 Cases at CTOGB–CHN

orthopedic

Abstract Background: A hand phlegmon is a deep, diffuse soft tissue infection without a well-defined abscess cavity, often involving the flexor tendon sheaths and fascial spaces. It is a potentially severe condition that can jeopardize hand function and, in advanced cases with systemic spread, may become life-threatening. Objective: To describe the epidemiological, clinical, therapeutic, and outcome features of hand phlegmons through a prospective study of 45 cases. Methods: We conducted a prospective, observational, and analytical study in the septic unit of the Grand-Bleu Traumatology and Orthopedic Center (CTOGB) at the National Hospital Center (CHN) of Nouakchott, from December 2023 to August 2024. All patients hospitalized for hand phlegmon during this period were included. Data were collected using a standardized questionnaire. Results: A total of 45 patients were included, with a mean age of 37.8 years (range: 7–74 years) and a sex ratio of 1.14, in favor of men. Diabetes was present in 46.6% of cases, several of which were poorly controlled. The mean consultation delay was 14 days. The most frequent sites were the index finger and thenar region (20% each). Pain was constant, followed by swelling and redness. The most common biological abnormalities were leukocytosis (80.4%) and positive CRP (77.7%). Bacteriological cultures were performed in eight patients, isolating Staphylococcus aureus and Gram-negative bacilli. Surgical treatment was performed in 95.5% of cases, consisting mainly of lavage and drainage. Amputation was necessary in 5 patients (7%). Serious complications included two cases of necrotizing fasciitis, one case of gas gangrene, and two deaths. Conclusion: Hand phlegmon is a frequent and severe surgical emergency. Delayed management, poorly controlled diabetes, and limited access to care increase the risk of complications. Prompt, multidisciplinary management is essential to improve prognosis

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