Introduction Infection of finger tip pulp usually thumb and index finger Pathophysiology mechanism penetrating injury including blood glucose needle stick splinters local spread may spread from paronychia no history of injury in 50% of patients pathoanatomy swelling and pressure within micro-compartments, leading to "compartment syndromes" of the pulp organism Staphylococcus aureus most common organism gram negative organisms found in immunosuppressed patients Eikenella corrodens found in diabetics who bite their nails 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 routine dressing changes Complications Finger tip compartment syndrome Flexor tenosynovitis Osteomyelitis Digital tip necrosis
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