hand infection Flashcards
Criteria of incisions for draining hand infections:
➢ Should be parallel, and never cross skin creases.
➢ Should be placed over the maximum point of tenderness or the site of abscess pointing.
➢ Avoid midline incision over the digits, instead a midlateral incision is done.
d. A drain should be inserted, either a tube drain or a piece of gauze.
Paronychia comp
Spread to the pulp space, or interphalangeal joint.
paronycia ttt
➢ Follow the general rules of treating hand infections
➢ Abscess drainage:
A. If pus is limited to one side: a small incision is made into the nail fold and raise a triangular flap over a drain. If the abscess is big, a small triangular
piece of skin overlying the abscess is removed to allow proper drainage.
B. If pus is tracking all around the nail fold: a long incision is made at the nail fold to evacuate the pus and to raise a rectangular flap of the skin over a drain.
C. If pus is under the proximal part of the nail (subungual): The proximal part of the nail overlying the abscess should be excised.
Chronic Paronychia ttt
It is usually due to fungal infection.
Treatment:
a. The hands should be kept dry
b. Use antifungal ointment dressing.
b. If this fails, excision of the nail or half of it is done with curettage of the nail bed
felon ccc
- Necrosis of terminal 2/3 of the distal phalanx (this will be manifested after 2 weeks on X-ray). Necrosis occurs because infection induces thrombosis in the digital arteries which are end arteries.
- Spread of infection to the nearby tendon sheath causing tenosynovitis or to inter-phalangeal joint causing septic arthritis
ttt of felon
➢ Abscess drainage:
a. In early cases:
A mid lateral straight incision is done over one side of pulp starting 0.5 cm distal to the distal crease and stopping short of the top of the finger. It is deepened flush with the bone to divide all the fibrous tissue septa.
b. Late cases:
1. A counter incision may be done on the opposite side of the pulp.
2. The mid lateral incision can be further extended across the tip of the nail to make a hockey stick incision.
WHY midlateral incision?
- The skin is less subjected to trauma thus it heals well
- Incision avoids injury of digital vessels and nerves
- A painful, tender midline wound might preclude proper finger function late after healing
Web Space Infection ccc
Complications:
1. Spread to the deep mid palmar space.
2. Spread to the adjacent volar spaces.
3. Spread to the adjacent web
web space infection ttt classic
Classically, drainage is done by a transverse incision over the palmar surface of the web over the site of maximum tenderness and swelling
, 1 cm from the free margin of the web to avoid injury of the digital nerves and vessels
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After drainage, press on the palm, if pus comes out this will indicate deep palmar space infection which should be drained also
Parona space
Parona space is bounded anteriorly by the ulnar and radial bursae, posteriorly by the pronator quadratus and interosseous membrane, on both sides by the deep fascia which is attached to the radius and ulna. Distally it is connected with the deep mid palmar space.
parona space infection drainage
Drainage:
It is done by a longitudinal incision starting 2 cm above styloid process of ulna, immediately in front of its subcutaneous border.
Ingrowing Toenail ttt
(2) Surgical treatment:
* Excision of a wedge on the affected side including the granulations and 1/3 of the nail and its bed. A tourniquet is essential. In extensive cases removal of the whole nail and its bed is done.
(1) Conservative measures: can be successful, in mild cases.
* The overhanging nail fold is pushed away and reduced in size by daily packing of the lateral groove with gauze soaked in a mild antiseptic.
- Warm water salt soaks.
- Antibiotic ointment.
- Avoid wearing tight shoes
Compound Palmar Ganglion ttt
Treatment: Antituberculous drugs with excision of the bursa (synovectomy
Aetiology of forearm space infection
It is always secondary to ulnar or radial bursitis or
mid palmar space infection
superficial mid palmar space infection ttt
formed abscess is usually collar stud in shape with one loculus superficial to the palmar aponeurosis and the other one is deep to the palmar aponeurosis.
ttt:Abscess drainage:
It is done via a transverse incision over the site of maximum tenderness. Then the floor is explored and the opening in the aponeurosis is enlarged and the subaponeurotic space is drained also via transverse incision in the palmar aponeurosis and a drain is left for 48 hours.
Deep Mid Palmar Space Infection ttt:
Drainage through a transverse incision in the line of the flexion crease passing across the middle of the palm. Palmar fascia is divided in longitudinal direction, to avoid digital nerves & vessels.
