Felon
Revision as of 15:22, 26 March 2015 by Rossdonaldson1 (talk | contribs)
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
- Dispo with followup in 2 days for wound check
- Ortho only if complications
See Also
Source
- Clark, DC. Common Acute Hand Infections. Am Fam Physician 2003;68:2167-76