This document discusses common hand infections, including paronychia, felon, pyogenic flexor tenosynovitis, collar button abscess, and deep space infections. It outlines the typical causative agents, clinical presentations, and treatment approaches for each type of infection. The key approaches to treatment involve prompt identification of the infection, initiating appropriate antibiotic therapy, surgical drainage if abscesses are present, and preventing long-term morbidity through adequate treatment.

1. Hand Infections
RAYMAR L. SIBONGA, MD FPOA
Hand and Reconstructive Microsurgery
Made Ridiculously Easy!

2. Hand Infections
Common ER
consult
Prompt
identification
Initiating
appropriate
medical/surgical
treatment
Prevent
morbidity.

3. COMMON HAND INFECTIONS
PARONYCHIA COLLAR BUTTON
ABSCESS
OSTEOMYELITIS
FELON DEEP SPACE
ABSCESS
HUMAN BITE
PYOGENIC FLEXOR
TENOSYVITIS
TB
FINGER PALM HAND
PARONYCHIA
FELON
PYOGENIC FLEXOR
TENOSYNOVITIS
COLLARBUTTON
ABSCESS
DEEP SPACE
ABSCESS
OSTEOMYELITIS
HUMAN BITE
TB

4. OBJECTIVES
NATOMIC CONSIDERATIONS
A
ACKGROUND
AUSATIVE AGENT AND CONTROL
B
C

5. ACUTE PARONYCHIA
INFECTION BENEATH THE NAILFOLD
A
NAIL BITING & MANICURE
S. aureus
B
C

6. ACUTE PARONYCHIA
• BETADINE SOAKS
• Antibiotics:
• Cephalexin
• Dicloxacillin
• Nafcillin
• Clindamycin
CONTROL
•Painful pus
formation/Fluctuance
I & D
•Pus Underneath
the nail plate-
Plate removal

7. ACUTE PARONYCHIA
HYPONYCHIUM- most resistant to infection

8. CHRONIC
PARONYCHIA
Eponychium
A
MOIST HANDS (swimmers,
dishwashers, bar tenders)
• 70- 90 % of cases (C.albicans)
• Superimposed bacterial infection
(P. aeruginosa)
B
C

9. CHRONIC PARONYCHIA
• Antifungal medication
• Nail plate removal
• Marsupialization
CONTROL

10. FELON
DEEP PULP INFECTION
A
PENETRATING TRAUMA
S. aureus
B
C
“Closed sac” of connective tissue subdivided into
multiple SEPTAE

11. FELON
• Elevation, soaks and antibiotics
• Incision and Drainage
• Thumb and small finger – RADIAL incision
• Other fingers – ULNAR incision
CONTROL

12. PYOGENIC FLEXOR
TENOSYNOVITIS
A
KANAVEL’s SIGN
S. aureus
B
C
DIGITAL SYNOVIAL SHEATH
HORSESHOE ABSCESS

13. Pyogenic
Tenosynovitis
• <24 H (HEALTHY)– attempt at non
operative management
• > 24H (IMMUNO COMPROMISED)-
Incision and irrigation
CONTROL

14. CLOSED
IRRIGATION (Neviaser)
CONTROL

15. COLLAR BUTTON
ASBCESS
A
FINGER ABDUCTION
S. aureus
B
C
WEBSPACE INFECTION
HOURGLASS ABSCESS

16. COLLAR BUTTON
ABSCESS
• Drain palmar and dorsal side
• Incisions should not be made through the webspace
to prevent contracture
CONTROL

17. DEEP SPACE INFECTIONS
CONTIGUOUS
SPREAD
PENETRATING
TRAUMA
HEMATOGENOUS
ROUTE
* THENAR
SPACE
MIDPALMAR
SPACE
HYPOTHENAR
SPACE
SUBAPONUEROTIC
SPACE SUBCUTANEOUS PLANE

18. DORSAL SUB-
APONEUROTIC
Extensor tendons and the
metacarpals and interossei muscles
Dorsal hand swelling
Incisions: inline with 2nd and 4th
webspaces
A
B
C
5cm
DORSAL HAND SWELLING

19. THENAR SPACE
Adductor pollicis (D), index finger
flexor tendon (V), adductor pollicis
insertion on the prox. Phalanx (R),
midpalmar septum (U)
Thumb palmarly abducted
Parallel to the first web space to
prevent contracture
A
B
C
THUMB PALMAR ABDUCTION

20. MIDPALMAR
SPACE
• 3rd & 4th metacarpals and
interossei (D), MF and RF
flexor tendons & lumbricals
(V), midpalmar septum (R),
hypothenar muscles (U)
Loss of palmar concavity lost
A
B
C
LOSS OF PALMAR CONCAVITY

21. HUMAN BITE
A
FIGHTBITE INURY
E. corrodens
B
C

22. CONTROL
HUMAN BITE
Early <8-12 hrs, NO ESTABLISHED
INFECTION
–ANTIBIOTICS
–Tetanus toxoid
–Culture and sensitivity
–Lavage
–Promote open drainage
–NO SUTURE
ESTABLISHED INFECTION
•ADMIT
•SURGERY
•C&S
•No suture or pins
•IV antibiotics
•Secondary closure, graft or
flap
•Early ROM

23. OSTEOMYELITIS
A
CONTIGUOUS SPREAD
S. aureus, Streptococcus,
Enterobacteriaeceae,
Pseudomonas, Pasturella,
Eikenella, other species
B
C
BONE

24. Osteomyelitis
• Surgical Debridement
• IV antibiotics - until resolution
of drainage
• Antibiotics: 4 - 6 weeks
• Consider amputation
CONTROL

25. Antimicrobial Therapy
• Superficial (cellulitis) – 10-14 days of oral antibiotics
• Tenosynovitis – 3 weeks parenteral antibiotics
• Septic arthritis – 3 to 4 weeks of parenteral antibiotics
• Osteomyelitis – 4 to 6 weeks of parenteral antibiotics

26. Mimics of Infection
“Biopsy what you culture,
Culture what you biopsy”

27. NEVER CLOSE AN INFECTED
HAND WOUND

28. END