Volar Finger Tip Infections / Felon

- See: Infections of the Hand

- Discussion:
    - if infection extends thru dermis, the pad of digit becomes involved;
    - usually cause by staph aureus;
    - barriers to proximal migration of infection:
          - anatomic arrangement of fibrous septum;
          - attachment of volar distal skin crease to deep fascia;
    - untreated felon:
          - destroys fat within septa;
          - spreads under periosteum into bone;
          - may involve flexor tendon sheath;

- Incision and Drainage:
    - anesthesia: r/o proximal cellulitis or lymphangitis prior to web space block;
    - volar longitudinal incision:
          - indicated for superficial felon which has resulted from foreign body (thorn or splinter);
          - in this situation the volar approach allows the most direct and least damaging method of drainage;
    - lateral - J - incision:
          - most indicated for deep felon w/o volar drainage nor foreign body (thorn or splinter)
          - central limb of incision should be made as close to tip of nail as possible in order to avoid damage to sensory area or N/V bundle;
                 - by keeping the incision dorsal, there is less chance of devascularizing the dorsal skin;
          - plan on incising the non contact aspect of the finger (radial aspect of the thumb and ulnar side of fingers);
                 - generally, it is not necessary to extend the incision all the way around the tip of the finger, unless the entire finger pad is distended w/ pus;
          - incision should extend down to periosteum in order to open septal compartments

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, August 23, 2012 10:53 am