Felon

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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

Felon
  • Red, tense, and markedly painful distal pulp space

Differential Diagnosis

Hand and finger infections

Look-Alikes

Diagnosis

Workup

  • Xray to assess for foreign body
  • Gram stain and culture (chronic infections may be caused by atypical organisms)

Evaluation

  • Usually a clinical diagnosis

Treatment

Incision and drainage

Incision of felon.
  • 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

See Also

References

  • Clark, DC. Common Acute Hand Infections. Am Fam Physician 2003;68:2167-76
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