Felon: Difference between revisions
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*Instruct pt to keep extremity elevated | *Instruct pt to keep extremity elevated | ||
*Antibiotics indicated for felons associated with cellulitis | *Antibiotics indicated for felons associated with cellulitis | ||
* | *Disposition with followup in 2 days for wound check | ||
* | *Hand specialist consult only if systemically ill or concern for complicated infection | ||
===[[Antibiotics]]=== | |||
{{Felon Antibiotics}} | |||
==See Also== | ==See Also== | ||
Revision as of 14:54, 22 April 2015
Background
- Subcutaneous pyogenic infection of the pulp space compartments of the distal finger
- Do not mistake for pulp erythema due to paronychia or herpetic whitlow
- Infection typically begins w/ minor trauma to dermis overlying finger pad
- May spread to flexor tendon sheath, IP joint, or underlying periosteum
- The inciting event is often a foreign body such as a splinter
Clinical Features
- Red, tense, and markedly painful distal pulp space
Diagnosis
- Gram stain and culture (chronic infections may be caused by atypical organisms)
Differential Diagnosis
Hand and finger infections
- Bed bugs
- Closed fist infection (Fight Bite)
- Hand cellulitis
- Hand deep space infection
- Hand-foot-and-mouth disease
- Herpetic whitlow
- Felon
- Flexor tenosynovitis
- Paronychia
- Scabies
- Sporotrichosis
Look-Alikes
Workup
- Xray to assess for foreign body
Treatment
Incision and drainage
- The incision should be made along the ulnar aspect of the index, middle, and ring fingers and along the radial aspects of the thumb and little finger.
- Number 11 blade is used to make incision on nonoppositional side of affected digit
- Start incision 5 mm distal to flexor DIP crease
- End incision 5mm proximal to nail plate border
- Bluntly dissect and explore wound until abscess is decompressed
no need for packing
Complications
DO NOT perform a "fishmouth" incision since it results in an:
- Unstable finger pad
- Neuroma
- Loss of Sensation
Disposition
- Instruct pt to keep extremity elevated
- Antibiotics indicated for felons associated with cellulitis
- Disposition with followup in 2 days for wound check
- Hand specialist consult only if systemically ill or concern for complicated infection
Antibiotics
Definitive treatment is drainage but antibiotic coverage for S. aureus and Strep with caution to identify Herpetic whitlow
- Cephalexin 500mg PO q6hrs daily x 7 days
- TMP/SMX 2 DS tablets PO q12hrs x 7 days
- Clindamycin 450mg PO q8hrs x 7 days
- Dicloxacillin 250mg PO q6hrs daily x 7 days
See Also
Source
- Clark, DC. Common Acute Hand Infections. Am Fam Physician 2003;68:2167-76