Felon: Difference between revisions
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==Treatment== | ==Treatment== | ||
===Incision and drainage=== | ===Incision and drainage=== | ||
[[File:Felon.jpg|thumb|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'''. | *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 | *Number 11 blade is used to make incision on nonoppositional side of affected digit | ||
| Line 36: | Line 36: | ||
*Loss of Sensation | *Loss of Sensation | ||
== | ==Disposition== | ||
*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 | ||
*Dispo with followup in 2 days for wound check | *Dispo with followup in 2 days for wound check | ||
*Ortho only if complications | *Ortho only if complications | ||
==See Also== | ==See Also== | ||
[[Hand and finger infections]] | *[[Hand and finger infections]] | ||
==Source== | ==Source== | ||
Revision as of 15:22, 26 March 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
- 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