- 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