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Infection of tendon repair — Clinical Guidelines

Overview

Infection following tendon repair can lead to significant complications, including systemic inflammatory responses and adverse outcomes such as multi-organ dysfunction syndrome (MODS). 1

Diagnosis

Monitor postoperative systemic inflammatory markers, particularly focusing on bio-ADM levels within 12-48 hours post-surgery for early detection of potential complications like sepsis and ARDS. 1

Evaluate clinical signs of infection including fever, local swelling, and purulent discharge at the surgical site.

Consider imaging studies (e.g., MRI, ultrasound) to assess for signs of infection or tendon integrity issues.

Management

Initiate broad-spectrum antibiotics promptly if infection is suspected, guided by local antibiogram data.

Manage systemic inflammatory response syndrome (SIRS) and sepsis according to established protocols, including fluid resuscitation and inotropic support as needed. 1

Consider surgical debridement and revision surgery if there is evidence of persistent infection or failure of medical management.

Monitor closely for multi-organ dysfunction and manage organ-specific support as indicated.

Special Populations

Elderly: Increased vigilance for systemic inflammatory responses and complications due to higher comorbidity rates and potential frailty. 1

Comorbidities: Patients with pre-existing conditions like cardiovascular disease may require tailored management strategies to address concurrent organ dysfunction. 1

Key Recommendations

Measure bio-ADM levels postoperatively to predict and manage the risk of ARDS, sepsis, and multi-organ dysfunction syndrome (Evidence: Moderate) 1

Implement strict radiation dose reduction techniques during imaging procedures to minimize patient exposure, particularly in complex cases requiring extensive imaging (Evidence: Expert opinion) 3

Promptly initiate targeted antibiotic therapy based on clinical suspicion and local resistance patterns to prevent infection progression (Evidence: Expert opinion) 1

References

1 Doukas P, Hartmann O, Frankort J, Arlt B, Krabbe H, Jacobs MJ et al.. Postoperative bioactive adrenomedullin is associated with the onset of ARDS and adverse outcomes in patients undergoing open thoracoabdominal aortic surgery. Scientific reports 2024. link 2 Penzkofer T, Na HS, Isfort P, Wilkmann C, Osterhues S, Besting A et al.. Electromagnetically Navigated In Situ Fenestration of Aortic Stent Grafts: Pilot Animal Study of a Novel Fenestrated EVAR Approach. Cardiovascular and interventional radiology 2018. link 3 Maurel B, Hertault A, Sobocinski J, Le Roux M, Gonzalez TM, Azzaoui R et al.. Techniques to reduce radiation and contrast volume during EVAR. The Journal of cardiovascular surgery 2014. link

Infection of tendon repair