Tether-induced tenosynovitis: The importance of an intact skin barrier
Agrawal S, and Watson P. Tether-induced tenosynovitis: The importance of an intact skin barrier. J Am Acad Dermatol 2017; 76(6):AB247
J Am Acad Dermatol
Introduction: Global Positioning Satellite (GPS) tethers can effectively monitor offenders. However, GPS tethers can have undesired medical consequences that merit consideration. The current design of the tether may predispose to breakdown of the skin barrier, leading to infection and severe health effects for the offender. Report of Case: A 63-year-old male with a history of uncontrolled type 2 diabetes mellitus, peripheral vascular disease, and osteomyelitis presented with a five-day history of left foot infection. Ten days prior, a GPS tether was placed on his left ankle with resultant trauma. The patient was febrile, and his ankle was erythematous and painful on palpation. One ulcer was present anteriorly, and another ulcer was present posteriorly. Deep wound cultures grew methicillin resistant Staphylococcus aureus (MRSA). Bone scan showed osteomyelitis of the left tibia. Ultrasound demonstrated septic tenosynovitis of the tibial tendon and septic arthritis of the left ankle. Incision and drainage was performed, with placement of a split thickness skin graft. The patient was discharged on six weeks of intravenous daptomycin. On follow up, the skin graft failed to take. Discussion: This case demonstrates the importance of an intact skin barrier and adequate wound healing in preventing infection, while highlighting potential deficits in the electronic monitoring system. The tether consisted of a heavy monitoring unit attached to an ill-fitting metal strap. The skin is a crucial component of the immune system, serving as a physical and chemical barrier to pathogens. The lack of protection between the tether and skin led to skin breakdown that progressed to infection. Changing the tether design may be warranted to limit prolonged pressure that leads to skin damage. Wound healing is a complex process affected by multiple factors including chronic medical conditions and vascular sufficiency. Currently, there is not a process to determine appropriate candidates for GPS monitoring from a medical perspective. Patients who are predisposed to poor wound healing should be assessed for these conditions prior to placing a tether. Presence of risk factors may even necessitate regular checks to detect skin breakdown. Although a tool for law enforcement, GPS tethers without adequate safeguards may cause harm. As the use of GPS tethers is expanding, this may present an opportunity by the dermatology community to improve the safety of this device.