If there is no improvement within 12 to 24 hours, surgical intervention is warranted. Early surgical treatment should be considered if the patient is immunocompromised or has diabetes. 24 Surgical treatment involves proximal and distal tendon exposure, and careful insertion of a catheter or feeding tube into the tendon sheath with copious intraoperative irrigation. 1 , 4 , 15 , 24 , 25 Postoperatively, the catheter may be left in place for 24 hours to allow for further low-flow irrigation. One retrospective study 29 questioned the utility of postoperative irrigation and found no difference in outcome whether the catheter was left in or taken out. Parenteral antibiotic therapy should be continued for at least 48 hours. Comparable oral antibiotic therapy should then be instituted and continued for an additional five to 14 days on an outpatient basis. Physical and occupational therapy should be initiated to reduce long-term disability from scarring and contractures.