Closed Irrigation in Pyogenic Flexor Tenosynovitis: A Practical Angiocatheter Modification and Review of Irrigation Aids

Pyogenic flexor tenosynovitis is a severe infection of the upper limb. While early mild cases may be treated conservatively, surgical intervention remains the standard of care for more advanced presentations. Closed irrigation techniques, typically performed using angiocatheters, are increasingly preferred over open approaches. We present a simple and widely accessible modification of an angiocatheter intended to facilitate multidirectional irrigation during closed catheter washout. This report does not evaluate irrigation efficiency, and any potential advantages remain theoretical. In addition, we compile available references on instruments and modifications intended to improve irrigation efficiency. This modification is feasible but unvalidated, and any theoretical benefits regarding fluid distribution or irrigation efficiency remain speculative. Furthermore, this report consolidated multiple previously described modifications into a single reference source. Our modification is low-cost, reproducible, and easily performed using commonly available tools. While it may offer a practical option during surgery, its clinical, mechanical, and fluid-dynamic performance has not been evaluated. Further research is required to assess safety, efficacy, and optimal design parameters.