Seminar on hand abscess

1. HAND
ABSCESS
PRESENTED BY:
DR. TAYYABA AFREEN
Reg No. 17M4618

2. SURGICAL ANATOMY OF THE HAND
Spaces of hand
 These are formed by fascia and fascial septae.
 Fascia and fascial septae of the hand are arranged in such a
manner that many spaces are formed.
 These spaces are important as they can get infected and
distended with pus.
Spaces of hand

3. Important spaces of the hand are :
Palmar Spaces
 Pulp space of fingers.
 Midpalmar space
 Thenar space
Dorsal Spaces
 Dorsal subcutaneous space
 Dorsal subaponeurotic space
The Forearm Space of Parona

4. Blood Supply of the Hand:
o Superficial palmar arch formed by ulnar
artery.
o Deep palmar arch is formed by radial artery.
Nerve Supply:
o Abductor pollicis brevis, flexor pollicis brevis,
opponens pollicis and 1st and 2nd lumbricals
are supplied by median nerve (5 muscles).
o Rest of the muscles in hand are supplied by
ulnar nerve (15 muscles).

5. PARONYCHIA
 It means infection of the lateral nail fold. It is the
commonest type of hand infection.
 If the infection extends to the eponychium it is termed as
“Eponychia”.
 When the infection involves both lateral nail folds and
eponychium it is called Run-around infection(Paronychia).
 In adults staphylococcus aureus is the most common
pathogen.
 There are two types of paronychia, acute and chronic.
Paronychia showing pointing pus.

6. Acute paronychia
 It occurs due to trimming of the nail or
ingrowing nail.
Risk factors: Hang nails, manicures,
penetrating trauma, nail bitting or sucking.
Clinical features:
o Initial swelling, erythema, tenderness with
progression to fluctuance, and abscess
formation typical.
o Spontaneous decompression can occur,
including tracking beneath the nail plate.
o Deeper infections can involve the nail bed
destruction, felon.

7. Treatment:
o Early cases (before formation of pus)
can be managed by soaking,
elevation, antibiotics and
immobilisation.
o Surgical decompression is the
treatment of choice.

8. Chronic paronychia
o Chronic paronychia occurs more commonly in
individuals constantly exposed to moist
environment.
o It is due to fungal infection moniliasis or due to
candida infections.
o It produces a dull nagging pain in the fingers. The
eponychium is faintly pink and nail is ridged.
Treatment:
o Antifungal agents such as nystatin or tolnaftate
solution helps the patient.

9. FELON
Felon is deep space infection or abscess of the distal
pulp of the finger or thumb.
 It is the second most common hand infection(25%).
 Index and thumb are commonly affected.
 Usually by a minor injury like finger prick.
Bacteria: Staphylococcus—most common.
Streptococcus, Gram-negative organisms.
Abscess(Felon)

10. Clinical Features:
o Fever.
o Tender axillary lymph nodes.
o Often suppuration is severe, forming collar
stud abscess which eventually may burst
o Pain, tenderness, swelling in the terminal
phalanx.
Treatment
o Incision and drainage under digital block
Volar longitudinal incision.

11. APICAL SUBUNGUAL INFECTION
 It is infection of the space between subungual epithelium and the
periosteum.
 It occurs after minor trauma or rarely after formation of subungual
haematoma.
 Excruciating tenderness with small visible pus under the tip (summit)
of the nail is the feature.
 Drainage with ‘V’ incision over the summit is the treatment along with
antibiotics.
APICAL SUBUNGUAL INFECTION

12. Clinical Features:
o Pain and swelling of palm in the region of web
space.
o Extremely tender and hot swelling.
o Finger separation sign: Adjacent fingers are
separated due to oedema.
o Gross oedema of the dorsum of hand.
o If untreated, pus from one web space can spread
to the other web space and to the other proximal
volar space.

13. Treatment:
Under anaesthesia, a transverse skin
incision is made and the pus is drained. The
skin edge is trimmed in such a way as to
leave a diamond-shaped opening to get better
drainage.

14. DEEP PALMAR ABSCESS
Two deep palmar spaces are present
 Midpalmar space.
 Thenar space.
 Infection of midpalmar space results in deep palmar abscess.
Causes:
 Penetrating injuries
 Haematoma
 Suppurative tenosynovitis
Clinical features
 Obliteration of normal concavity of the palm
 Gross oedema of the dorsum of the hand
 Extreme tenderness in midpalmar space
 MP joint movements are painful.
 IP (interphalangeal) joint movements are not painful.

15. Treatment:
o Elevation of affected limb.
o Antibiotics and analgesics.
o Drainage:Under anaesthesia, a transverse crease
incision is made and once the palmar aponeurosis
is seen, it is split longitudinally in the direction of the
fibres to avoid damage to nerves and vessels.

16. ACUTE SUPPURATING TENOSYNOVITIS
It is the bacterial infection of flexor tendon sheaths.
Clinical features:
 The patient gives history of pricking type of injuries.
 Symmetrical, fusiform painful enlargement of finger.
 Flexed, fixed finger-'Hook sign’.
 IP joint movements are very painful: Severe pain on
passive finger extension.
 MP joint movements are not painful: This sign
differentiates suppurating tenosynovitis from deep
palmar abscess.
 When there is infection of ulnar bursa, the maximum
tender spot is in between the two palmar creases. This
sign is described as' Kanavel's sign'.

17. Treatment:
 Elevation of the affected limb.
 Antibiotics and analgesics.
 Position of rest.
 Drainage under general anaesthesia. Incisions are placed over the
site of maximum tenderness and flexor sheath should be opened up.
Many a times multiple incisions are required.
SUPPURATING TENOSYNOVITIS

18. HERPETIC WHITLOW
 Herpetic Whitlow is an intensely painful
infection of the hand involving one or more
fingers that typically affects the terminal
phalanx.
 Commonly involves thumb and index
finger.
Risk factors:
o Genital herpes in self or partner.
o Health care worker.
o Children with gingivostomatitis.
Fig: Herpetic Whitlow

19. Clinical features:
oLocalised pain, pruritus and swelling
followed by the appearance of clear vesicles.
oTypically localised to one finger only.
oIn latest stages coalescene of vesicles to
form an ulcer.
Treatment:
Self limited disease.
oIncision is contraindicated as it spreads the
infection may lead to herpetic encephalitis.
oUnroofing relieves the pain.
oTropical antifungals can be applied.

20. THANK YOU