| Introduction |
 Infection of finger tip pulp
- usually thumb and index finger
- Mechanism
- penetrating injury including
- blood glucose needle stick
- splinters
- may spread from paronychia
- no history of injury in 50% of patients
- Organism
- Staphylococcus aureus
- gram negative organisms
- found in immunosuppressed patients
- Eikenella corrodens
- found in diabetics who bite their nails
- Pathoanatomy
- swelling and pressure within micro-compartments, leading to "compartment syndromes" of the pulp
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| Anatomy |
- Fingertip micro-compartments
- pulp fat is separated by fibrous vertical septae running from distal phalanx bone to dermis
|
| Presentation |
- Symptoms
- pain, swelling
- Physical exam
- tenderness on distal finger
|
| Treatment |
- Operative
- I&D in emergency room followed by IV antibiotics
- indications
- most cases due to risk of finger tip compartment syndrome
|
| Techniques |
- Fingertip irrigation & debridement
- approach
- keep incision distal to DIP crease
- to prevent DIP flexion crease contracture and prevent extension into flexor sheath
- mid-lateral approach
- indicated for deep felons with no foreign body and not discharging
- incision on ulnar side for digits 2,3 and 4 and radial side for thumb and digit 5 (non-pressure bearing side of digit)
- volar longitudinal approach
- most direct access
- indicated for superficial felons, foreign body penetration or visible drainage
- incisions to avoid
- fishmouth incisions - leads to unstable finger pulp
- double longitudinal or transverse incision - injury to digital nerve and artery
- debridement
- avoid violating flexor sheath or DIP joint to avoid spread into these spaces
- break up septa to decompress infection and prevent compartment syndrome of fingertip
- obtain gram stain and culture
- hold antibiotics until culture obtained
- postoperative
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| Complications |
- Finger tip compartment syndrome
- Flexor tenosynovitis
- Osteomyelitis
- Digital tip necrosis
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