Pyogenic tenosynovitis is a severe soft-tissue infection that can lead to significant morbidity and potential amputation. Early soft-tissue coverage, such as using a McGregor flap, is advocated to enhance vascular supply and combat infection. This case report details the management of a 65-year old woman with type II diabetes and severe tenosynovitis using a McGregor flap, highlighting its characteristics, challenges, and outcomes.

A 65-year old woman with newly diagnosed type II diabetes presented with a neglected palmar wound and signs of tenosynovitis in the 1st and 2nd fingers. Imaging ruled out osteitis. Surgical intervention involved entrance excision, Bruner incision, and debridement of necrotic tissues. Due to persistent necrosis and thrombotic volar pedicle, a McGregor flap was harvested from the groin and used to cover the tissue defect.

Postoperative care included immobilization, pain management, and early mobilization exercises. The flap was divided during the third week. Long-term follow-up revealed no residual pain and a 75% restoration of overall range of motion in the affected hand.

Early soft-tissue coverage with a McGregor flap is advocated for managing severe pyogenic tenosynovitis. This approach offers advantages such as versatility, reproducibility, vascular stability, and minimal donor site morbidity. While disadvantages like postoperative stiffness and sensory loss exist, the McGregor flap remains valuable for complex hand injuries, providing reliable coverage and facilitating early rehabilitation.

This case report demonstrates the successful use of a McGregor flap in managing severe pyogenic tenosynovitis in a patient with diabetes. Early soft-tissue coverage enhanced vascular supply, aided in combating infection, and contributed to a positive functional outcome with no residual pain and significant restoration of range of motion.