Paronychia/ Felon

Question 1

What issue/tx
(1) Acute presents with localized pain and tenderness. The nail fold appears erythematous and inflamed, and a collection of pus usually develops. Early in the course, cellulitis alone may be present. An abscess can form if the infection does not resolve quickly.
(2) Develops along the nail margin (proximal and lateral nail folds), manifesting over hours to days with pain, warmth, redness and swelling.
(3) Pus accumulates behind the cuticle, sometimes spreading beneath the nail or deeper into the lateral nail folds.

Answer 1

Paronychia
Treatment
(1) Early treatment with warm compresses or soaks.
(2) Antibiotic therapy if warranted that includes coverage for Staph and strep.
(3) Bactrim/Septra DS in areas where MRSA is common and based on results of sensitivity testing.
(4) Fluctuant or visible pus should be drained using scalpel blade inserted between the nail and nail fold.
(5) Skin incision is unnecessary

Question 2

______ is an acute inflammatory process, with or without abscess formation, that involves the proximal and lateral nail folds and that has been present for less than six weeks.
-is the most common infection of the hand, representing 35% of all hand infections in the United States.

Answer 2

Paronychia

Question 3

Acute paronychia of the toes occurs in most cases in association with _______

Answer 3

ingrown toenails

Question 4

Common favoring factors for paronychia

Answer 4

nail biting, thumb sucking, and pickingat a hangnail.

Question 5

Paronychia Complications

Answer 5

(1) Further extension of the infection and deeper involvement.
(2) Nail distortion in chronic infections.

Question 6

________ is an abscess of the distal phalanx fat pad. S. aureus is the most common pathogen. The patient usually presents with a painful and swollen distal pulp space.

Answer 6

Felon

Question 7

The digital pulp, the fleshy mass at the finger tips, is divided into multiple compartments by ________ that provide structural support.

Answer 7

fibrous septae

Question 8

True/False
Felon nearly always follows minor finger injury

Answer 8

True

Question 9

What issue / Tx
(1) Condition is characterized by severe pain, exquisite tenderness, and tense swelling of the distal digit with erythema. There may be a visible collection of pus or palpable fluctuance.
(2)Septa between the pulp spaces limits the spread of infection, resulting in an abscess, creating pressure and necrosis of adjacent tissues.
(3)Underlying bone, joint or flexor tendons may become infected.

Answer 9

Felon
Treatment
(1) Prompt incision, with division of the fibrous septa to ensure adequate drainage.
(2) Should be performed by Dermatologist if available.
(3) IDC should treat with antibiotics.
Disposition
(a) Medevac for IND
(b) Light Duty, no use of affected hand until signs of infection have resolved andwound has healed.

Question 10

Complications Felon

Answer 10

(a) Osteitis & osteomyelitis
(b) Ulceration and tissue necrosis
(c) Flexor tenosynovitis
(d) Septic arthritis

Question 11

Felon Differential Diagnosis:

Answer 11

Cellulitis