Hand Infection Dr. Weiguo Hu Dr. Weihua Qiu Department of
Surgery Rui Jin Hospital Shanghai Jiao Tong University School of
Medicine Slide 2 Anatomy factors Multiple compartments and planes
in hand Infections are dictated by fascial boundaries in hand
Background Slide 3 Paronychia Felon Tenosynovitis Deep fascial
space infections Classifications Characteristic Slide 4 The lateral
nail fold Starting as a cellulitis, progression to abscess
formation Eponychia (spreads to the proximal nail edge) Paronychia
Characteristic Slide 5 Recent trauma to lateral nail fold Nail
biting Manicuring Dishwashing Finger sucking children Paronychia
history Slide 6 Edema, Erythema, Pain along lateral edge of nail
fold May have extension to proximal nail edge (eponychium) Possible
abscess formation Paronychia Signs & Symptoms Slide 7
Staphylococcus & Streptococcus in most cases Mycobacteria and
fungi in chronic cases or immunocompromised patients Anaerobes in
the pediatric population due to finger sucking. Etiology
Microorganism Slide 8 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 Management Slide
9 Slide 10 Slide 11 Slide 12 Eponychia (Subungual abscess )
Osteomyelitis of the distal phalanx Development of a felon Chronic
infection Complications Slide 13 Most resolve in 2-4 days Chronic
infections are likely fungal infections. Prognosis Slide 14 The
infection of distal palmar phalanx Felon Characteristic Slide 15
Compartmentalized infection Increased pressure within the closed
compartment Impaired venous outflow a local compartment syndrome
and myonecrosis and osteomyelitis Felon Characteristic Slide 16
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 Etiology Microorganism Slide 17 Recent trauma
to finger pad or paronychia Typically Throbbing Pain Swelling,
Pressure, Erythema Felon Signs & Symptoms Slide 18 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 Felon Signs
& Symptoms Slide 19 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 Slide 20 scarring sensory loss unnecessary pain
instability of the finger pad spread of infection into the adjacent
tendon sheath. Incision & Drainage Slide 21 Slide 22 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 Felon Follow up
Slide 23 Osteomyelitis Necrosis Sinus tract formation Septic joint
Tenosynovitis Complications Slide 24 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 Slide 25
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 Slide 26 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 Infectious Tenosynovitis Slide 27 Tendon destruction
Functional disability Extension of infection to deep fascial space
Complications Slide 28 Deep fascial space infections midpalmar
space thenar space dorsal subaponeurotic space subfascial web space
Slide 29 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 Deep fascial space infections Slide 30
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 Midpalmar space
infections Slide 31 Marked swelling of the thumb-index web space
Flexed and abducted resting posture of the thumb Pain with passive
adduction Thenar space infections Slide 32 Functional disability
Tendon destruction Sepsis Hand loss Complications Slide 33 pain
relief antibiotic therapy elevating and immobilizing the hand
consulting an experienced hand surgeon incision and drainage
Management Slide 34 Slide 35 Depending on the extention of tissue
destruction bony involvement preexisting vascular insufficiency
systemic complications (bacteremia, sepsis) Prognosis Slide 36 Tons
of Thanks
