Felon

Question 1

What is a felon?

Answer 1

1. Closed-space infection of the fingertip pulp
   *thumb and index finger are the most commonly affected

Question 2

What are the causes of a felon?

Answer 2

1. Staph aureus is the most common causes (MRSA)
2. Gram-negative in immunosuppressive patients
3. Eikenella corrodens
   *for diabetics who it their fingernails

Question 3

What is the patho physiology of a felon?

Answer 3

1. The fingertip have numerous compartments
2. Infection occurring within these compartments can lead to abscess formation, edema, and rapid development of increased pressure in a closed space
   *can compromise blood flow and lead to necrosis

Question 4

What are the PE findings

Answer 4

1. Pain
2. Erythema
3. Swelling
4. Tense/tight/firm
5. Possible drainage

Question 5

What diagnostic tests will be completed?

Answer 5

Cultures

Question 6

What are some of the complications?

Answer 6

1. With skin necrosis, spontaneous decompression may occur
   *when skin does not yield osteomyelitis, tenosynovitis, and septic arthritis may ensue

Question 7

What is the treatment?

Answer 7

1. Early = antibiotics
2. Decompress (incision) to preserve venous flow if tension is present
3. Culture
4. Update tetanus

Question 8

What are the surgery options>

Answer 8

1. Digital block (numb the finger, cut it open let it drain)
2. Pack loosely with gauze
   **DO NOT cross the DIP joint (risk of cutting flexor tendon)
3. Splint and elevate finger
4. Follow up within 2 days for re-eval

Question 9

What antibiotics are going to be used?

Answer 9

1. Empirical coverage for S aureus and strep organisms until culture available
   *dicloxaillin, E-my in, Keflex (no coverage against MRSA), nafcillin, Bactrim DS