DEEP SPACE AND WEB SPACE INFECTIONS

Question 1

3 deep spaces in the palm

Answer 1

1. Thumb space
2. Mid-palmar space
3. Hypothenar space

Question 2

Thenar space

Answer 2

• potential space/ bursa between thumb and 3rd MC
• separated from mid-palmar space by fascial septum
• lies volar to adductor pollicis and dorsal to flexor tendons
• contains flexor tendons to thumb and IF, thenar muscles and 1st lumbrical

Question 3

Incisions for surgical drainage of thenar space infections

Answer 3

2 incision technique
On volar side, curved incision along thenar crease
On dorsal side, longitudinal incision over web space

Question 4

Hypothenar space

Answer 4

• potential space/ bursa volar to 5th MC
• separated from mid-palmar space by fascial septum
• only contains hypothenar muscles

Question 5

Incision for surgical drainage of hypothenar space infections

Answer 5

Volar longitudinal incision directly over hypothenar space

Question 6

Mid-palmar space

Answer 6

• space between 3rd and 5th MC
• separated from thenar and hypothenar spaces by fascial septa
• contains flexor tendons to MF, RF and LF, as well as 2nd, 3rd and 4th lumbricals

Question 7

Incision for surgical drainage of mid-palmar space infections

Answer 7

Transverse incision along proximal palmar crease from LF to MF

Question 8

Space of Parona

Answer 8

• potential space in distal forearm
• superficial to PQ and deep to long flexor tendons
• distally continuous with mid-palmar space
• proximally extends to FDS arch

Question 9

Incisions for surgical drainage of horseshoe abscess

Answer 9

3 incision technique

• transverse incision over DIPJ of LF
• transverse incision over IPJ of thumb
• extended carpal tunnel approach proximally

Question 10

Collar button abscess

Answer 10

• web space infection

- can spread proximally via lumbrical tunnels

Question 11

Incisions for surgical drainage of collar button abscess

Answer 11

2 incision technique
- on volar side, zigzag incision
- on dorsal side, longitudinal incision
Avoid skin in actual web space = to prevent web space contracture