Download No Slide Title

Hand Infection
Dr. Weiguo Hu 胡伟国
Dr. Weihua Qiu 邱伟华
Department of Surgery
Rui Jin Hospital
Shanghai Jiao Tong University School
of Medicine
Background：

Anatomy factors

Multiple compartments and planes in
hand

Infections are dictated by fascial
boundaries in hand
Classifications：Characteristic

Paronychia

Felon

Tenosynovitis

Deep fascial space infections
Paronychia：Characteristic

The lateral nail fold

Starting as a cellulitis,
progression to abscess
formation

Eponychia (spreads to
the proximal nail edge)
Paronychia：history
Recent trauma to lateral nail
fold

Nail biting

Manicuring

Dishwashing

Finger sucking （children）
Paronychia：Signs & Symptoms



Edema, Erythema, Pain
along lateral edge of nail
fold
May have extension to
proximal nail edge
(eponychium)
Possible abscess formation
Etiology： Microorganism

Staphylococcus & Streptococcus in most
cases

Mycobacteria and fungi in chronic cases
or immunocompromised patients

Anaerobes in the pediatric population due
to finger sucking.
Management：




If no frank abscess
frequent hot soaks & antibiotics
If pus is present
incision and drainage
If pus has tracked beneath the nail
remove an adjacent longitudinal
section
If eponychia is resulted
remove the entire nail plate
Complications：

Eponychia (Subungual abscess )

Osteomyelitis of the distal phalanx

Development of a felon

Chronic infection
Prognosis：

Most resolve in 2-4 days

Chronic infections are likely fungal
infections.
Felon：Characteristic
The infection of distal palmar phalanx
Felon：Characteristic

Compartmentalized infection

Increased pressure within the closed
compartment

Impaired venous outflow

a local compartment syndrome and
myonecrosis and osteomyelitis
Etiology： Microorganism
Staphylococcus & Streptococcus is the most common
causative organism

Typically direct inoculation of bacteria by
penetrating trauma

May be caused by hematogenous spread

Local spread from an untreated paronychia
Felon：Signs & Symptoms

Recent trauma to finger pad or paronychia

Typically Throbbing Pain

Swelling, Pressure, Erythema
Felon：Signs & Symptoms




Painful, Tense,
Erythematous finger pad
Pointing of abscess possibly
present
Signs typically limited to
area distal to the distal
interphalangeal joint
Evidence of penetrating
trauma
Incision & Drainage





Frank abscess & tense finger pad is the
indication
A longitudinal incision over the area of greatest
fluctuance
To avoid penetration of the tendon sheath, the
incision should not extend to the distal
interphalangeal crease
Using a hemostat, bluntly dissect the wound to
promote drainage
Irrigating the cavity copiously and loosely pack
with a gauze wick.
Incision & Drainage





scarring
sensory loss
unnecessary pain
instability of the finger pad
spread of infection into the adjacent
tendon sheath.
Felon：Follow up

Reevaluate the wound 48 hours after initial
incision

If continued drainage is present, loosely repack the
wound

If no further drainage is present, repacking is
unnecessary

Continue antibiotics for 5-7 days

The prognosis is good, with healing in 1-2 weeks
Complications：

Osteomyelitis

Necrosis

Sinus tract formation

Septic joint

Tenosynovitis
Infectious Tenosynovitis


The tenosynovial coverings
of the second, third, and
fourth digits do not
communicate with either
the radial or ulnar bursae
in most individuals
Infection within a tendon
sheath usually is the result
of direct inoculation of
bacteria from penetrating
trauma.
Infectious Tenosynovitis





Recent penetrating trauma to hand
Gonococcal infection, particularly
disseminated infection
Pain, especially with passive extension of
finger
Edema of entire finger
Variable history of fever
Infectious Tenosynovitis




Tenderness along the course of the flexor
tendon
Symmetric edema of involved finger
Pain on passive extension (the most
important sign)
Flexed resting posture of finger
All 4 signs possibly not present early in the course
of infection
May have associated lymphangitis,
lymphadenopathy, and fever
Complications：

Tendon destruction

Functional disability

Extension of infection to deep fascial
space
Deep fascial space infections

midpalmar space

thenar space

dorsal subaponeurotic space

subfascial web space
Deep fascial space infections





Recent penetrating trauma to hand or
untreated tenosynovitis
Palmar blister (may result in subfascial
web space abscess)
Pain and edema of hand
Pain with movement of fingers
Variable history of fever
Midpalmar space infections

Pain, swelling, loss of palmar concavity

Pain with movement of the third and
fourth digits

Dorsal swelling secondary to the tracking
of infection dorsally along the lymphatics
Thenar space infections

Marked swelling of the thumb-index web
space

Flexed and abducted resting posture of
the thumb

Pain with passive adduction
Complications：

Functional disability

Tendon destruction

Sepsis

Hand loss
Management：

pain relief

antibiotic therapy

elevating and immobilizing the hand

consulting an experienced hand surgeon

incision and drainage
Prognosis：
Depending on

the extention of tissue destruction

bony involvement

preexisting vascular insufficiency

systemic complications (bacteremia,
sepsis)
Tons of Thanks！