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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