These compartments are septated and thus discrete. This can be achieved by using an 11 or 14 blade scalpel to incise just above the nail bed, along the eponychial fold, without actually cutting through the eponychial skin itself. A patient may want to know the risks of deferring incision and drainage. Generally speaking, you may need to be off work for 1-4 weeks, depending on the severity of your infection and the type of work that you do. The information is not intended to replace the advice of a health professional. Victorians are in this together and together we will get through this. The cellulitis stage can be treated with hot soaks and antibiotics, with close followup (see the section on hot soaks, above). The MHS website does not host or receive funding from advertising or from the display of commercial content and there are no conflicts of interest to declare. The abscess stage needs surgical drainage, which may be done in the office but might require a trip to the operating room. It got worse and formed an abscess. How does it happen? He was admitted to the hospital for IV antibiotics, and a special kind of IV was placed, called a PICC line, so he could get his treatment (6 weeks of IV antibiotics) at home. There is a dearth of evidence to support medical versus surgical management, but it’s generally accepted that when pus and fluctuance is present, it is prudent to get it out. These fingertip infections usually come from some type of penetrating injury, such as a small laceration (cut) or a splinter, but sometimes we cannot find any specific reason.

The open wound was small, only about 4 mm, but it went all the way down to the bone.

Remember the admonition from the Patient Education Links Page: the Internet has a lot of information, much of it incorrect. The prognosis is excellent if the infection is treated properly. This can happen when the fingertip is invaded by something foreign such as a splinter, a piece of glass or if you stuck yourself with something. Blood tests by finger sticks are also culprits for causing a felon. This is normal. The hot soaks should be repeated five times a day. The unique anatomy of the fingertip determines the details of how these are treated. The problem is that antibiotics cannot treat an abscess, it needs to be opened up and drained. Note that the normal dead skin, the callus, has been falling off. One of the risks of surgery is that you may have altered sensation at the site of the incision (numbness, hypersensitivity or a feeling of unpleasantness); to avoid this, where possible the incision will not be made on the part of the pulp that is most frequently used to touch or hold objects. The treatment depends on the form or stage of the infection.

Here’s my advice on where to place your incision, based on common-sense knowledge of the anatomy: Paronychias and felons are pesky finger tip infections that the everyday emergency and urgent care practitioner should expect to come across on a regular basis. Surgery is performed if you are thought to have an abscess (a collection of pus), contaminated wound or a foreign body (such as a splinter) in your fingertip. Hot soaks consist of putting the hand into very warm water: not hot enough to hurt, but hot enough to make the hand very red. If the felon has progressed to the point of forming an abscess, surgical drainage is needed.

Sometimes it is difficult to tell which stage the paronychia is in, and since the treatments are completely different, it is important to see a good hand surgeon. The xray showed some reconstitution of the missing bone. However, I may not agree with all that is on that site, and it may have changed since I reviewed it. For this reason antibiotics like "flucloxacillin" or "cephalexin" are commonly prescribed for a felon, because they cover the most common bacteria. The general guideline, as with any abscess, is to incise along the area of greatest tenderness and fluctuance. Pus forms under the skin and spreads throughout the pulp. The red means that there is a lot of increase blood flow to the hand, bringing the body's natural infection-fighting cells to the site as well as lots of antibiotics. The pain resolved after surgery and the patient was sent home on IV antibiotics after a few dats. The MHS website aims to inform patients and health professionals about hand surgery, illness prevention and the practice philosophy of Dr Jill Tomlinson. We are closed on Fridays. Another more significant, but acceptable procedure for the more developed felon is the through-and-through incision and drainage, described in the video below. Felons are generally caused by penetrating trauma to the finger tip. Infection within them causes intense pain and swelling of the fingertip that a patient usually will not ignore for long. He was taken that day to the operating room, about two hours afterwards. This reduces swelling. A felon is an infection of the fingertip pulp that come in two forms: cellulitis, which is a non-pus forming infection, and an abscess (a cavity of pus). More commonly (or when it’s tough to determine where the worst fluctuance is), a midline high longitudinal fat pad incision is another good choice. Additives such as epson salts are not needed, but some patients like to add it anyway. Website Design by Blue Oak Web Design. Yes. I also took an xray, and the bone was also infected (this is called osteomyelitis), with some of the bone eaten away. COVID news: Elective surgery restrictions have been lifted and we will resume all elective surgeries from 28 September. Streptococci are also common causes.

I’d defer these more radical procedure to the expertise of a hand surgeon and avoid them in the ED. Community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is certainly a consideration in this day and age in prevalent areas as well. Thank you for your understanding as our community works through these unprecedented times together (last updated: 22 September 2020). If the problem is only a cellulitis, hot soaks and oral (pills by mouth) antibiotics will do the trick, but close observation (office visits every other day or so) is needed. "Felon" is the medical term for an infection of the finger or thumb pulp (the fleshy area of the finger/thumb where your fingerprints are). As Epworth Cliveden remains indefinitely closed at this time Dr Tomlinson does not have any regular surgical lists at Epworth, but her lists continue at The Avenue and Glenferrie Private. He was referred to me. The diagnosis was made of a felon that had progressed to the abscess stage. Â. Felon. They usually start out as only slightly tender but can rapidly progress to extremely painful.

See my page on paronychias. I also called the infectious disease specialist to coordinate the antibiotic care. A paronychia is an infection occurring just beneath the eponychial folds. Could it be both? Hockey-sticking or “fish-mouthing” may be needed for definitive treatment of a very severe felon, but can result in an unstable finger and compromise blood flow to the finger pulp. If you develop a complication, such as infection of the bone, you may need to take antibiotics for at least 6 weeks and additional follow-up with X-rays will be required. The wound has almost completely closed, the pain is gone, the redness is resolving. It can be difficult to drain a nasty pulp infection, because the pulp has many interconnecting channels within it, which gives bacteria lots of different little areas to hide in.

I released the pus, cleaned out the dead tissue, and cut off the dead callus. The MHS website's content is designed to complement, not replace, the relationship between a patient and his/her own doctor.

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This can include cuts, splinters, or even the seemingly benign needle stick of a glucose check for a diabetic patient. If you have a visible wound from your original injury this will be probed and washed. There are basically two types of fingertip infections: infections of the pulp (the soft, fatty part where your fingerprint is), called a felon; and infections of the area around the fingernail, called a paronychia. Generally speaking, it is better to avoid transverse incisions, which have a higher risk of transecting digital nerves and arteries. Keep in mind NOT to cut below the distal interphalangeal joint crease, which can lead to damage to the flexor tendon. On your examination, the nail fold seems swollen and tender, but there is also some tenderness and tenseness of the pulp of the digit as well. When you are in hospital these will usually be administered intravenously (through a "drip"). Ideally, incision and drainage should allow egress of the infection with minimal damage to the nail bed. Curiously more indolent paronychias are sometimes attributable to anaerobic infection, from oropharyngeal bacteria–this is thought to be due to one of the causative mechanisms (nail biting). Created 15 August 2012, last modified 28 January 2013.
You may need more than one operation.

If you are able to work with a simple dressing on your finger (such as for office duties) you may be able to return to work 1-2 weeks after leaving hospital. If treatment is delayed and your infection is slow to clear up you are at risk of skin necrosis (skin death), septic arthritis (joint infection), osteomyelitis (bone infection) and tenosynovitis.
Common culprits are nail fold trauma allowing the ingress of bacteria, such as manicures, nail biting, or even the application of artificial nails. He developed a felon, and tried to drain it with his pocket knife.

Phone: 415-925-0501 | Address: 1363 South Eliseo Drive, Suite B, Greenbrae, CA 94904, © Copyright 2012 David Nelson, MD. The most common bacterial cause is Staphylococcus aureus (Golden Staph), which is one of the most common bacteria found on the skin. He next saw several doctors who prescribed antibiotics. This can include cuts, splinters, or even the seemingly benign needle stick of a glucose check for a diabetic patient. The abscess was actually smaller than it might have been. This site complies with the HONcode standard for trustworthy health information: verify here. Coincidentally, this is considered a less morbid incision. You wonder if you are dealing with a paronychia or a felon.

Some advocate for a trial of antibiotics before incision and drainage for an early felon, as per this very brief evidence-based review. A felon is an infection occurring within the compartments of the fingertip pulp. If any of the information is not consistent with what I have told you, please download the material and bring it in. A paronychia is an infection around the edge of the fingernail. take regular antibiotics. Post was not sent - check your email addresses! Early treatment is preferable for a quick and full recovery.

Incision & drainage? During surgery your surgeon will take swabs or tissue samples which are sent to the microbiology laboratory for testing, so that the type of bacteria can be identified and we can determine what type of antibiotics are best suited to the particular infection that you have.


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