The Journal of Bone and Joint Surgery, Vol 69, Issue 8 1161-1168, Copyright © 1987 by Journal of Bone and Joint Surgery, Inc
Mycobacterium marinum infection of the hand and wrist. Results of conservative treatment in twenty-four cases
SP Chow, FK Ip, JH Lau, RJ Collins, KD Luk, YC So and WK Pun
University of Hong Kong at Queen Mary Hospital.
Inadequate debridement, extensive scarring, and breakdown of the wound have
been commonly encountered after surgical debridement has been employed as
the initial treatment of infection with Mycobacterium marinum involving the
deep structures of the hand. Because of our disappointment with the results
of this form of treatment, from 1982 to 1986 we treated twenty-four
patients who had such an infection with rifampicin and ethambutol after a
diagnostic biopsy was done. Surgical treatment was deferred until it was
determined that the infection had not been controlled by the chemotherapy.
The clinical outcome for these patients could be divided into three
patterns: eleven patients (Group I) had a good result with no
complications, three patients (Group II) had delayed healing of the wound,
and ten patients (Group III) did not have a good response to conservative
treatment and required one or more surgical debridements. Complications
were sometimes associated with use of the drugs, and loss of visual acuity
was a concern in three patients. In twenty-one (87 per cent) of the
patients, at follow-up the function of the treated hand was equal to that
of the other hand. Persistent pain, a discharging sinus, and previous local
injection of steroids were unfavorable prognostic factors. If these factors
are present, surgical debridement is advised.
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