ID
Felon
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Felon
, Finger Pulp Abscess, Whitlow
See Also
Paronychia
Hand Infection
Definitions
Felon (Finger Pulp Abscess, Whitlow)
Infection of closed space of distal phalanx pulp
Pathophysiology
Infection contained within compartment walled by the fibrous septae of the finger pulp
Causes
Staphyococcus aureus
Streptococcus
species
Mechanism
Local finger tip
Puncture Wound
Splinter
Glass fragment
Punctures (e.g. Finger-stick
Blood Sugar
testing)
Symptoms
Rapidly increasing pressure and pain at finger tip
Thumb and index finger most commonly affected
Signs
Tense, swollen and erythematous of the finger pad (pulp)
Differential Diagnosis
Paronychia
Herpetic Whitlow
Cellulitis
Tuft Fracture
Imaging
Bedside Ultrasound
May demonstrate fluid collection within pulp
Complications
Osteomyelitis
of distal phalanx
Tissue necrosis of finger pulp
Contiguous spread
Pyogenic Flexor Tenosynovitis
Does not typically spread to adjacent DIP joint (infection typically contained within fibrous septae)
Management
Conservative measures
Tetanus Prophylaxis
Warm soaks
Elevate the hand
Antibiotics for 7 to 10 days (not typically needed for isolated abscess AFTER
Incision and Drainage
)
Cephalexin
(
Keflex
)
Dicloxacillin
Trimethoprim-Sulfamethoxazole
Amoxicillin
-Clavulanate (
Augmentin
)
Clindamycin
Management
Early
Incision and Drainage
Indications
Clear abscess pocket identified
No improvement after 24 hours conservative therapy
Contraindications
Herpetic Whitlow
Anesthesia
Digital Block
(
Metacarpal Block
)
Technique
Apply
Tourniquet
at base of finger
Identify point of maximal tenderness and swelling
Make 5-10 mm incision using method below
No specific point of tenderness
Make straight single volar (superficial abscess) or high lateral incision (deep abscess)
Start incision 3-5 mm distal to DIP joint
Keep lateral incision within 5 mm of nail border
Continue incision distally to distal phalanx tip
Thumb and pinky finger: Incise radial side
Index, long and ring fingers: Incise ulnar side
Avoid incision methods with higher risk of scar
Transverse palmar incision
J-shaped incision
Fish mouth incision
Wound
exploration
Gently open subcutaneous tissue with hemostat
Irrigate wound
Pack with sterile gauze for 48 hours
Complications
Painful neuroma
Finger pad instability
Scarring
Follow-up care
Splint and elevate for 48 hours
Saline soaks twice daily
Maintain range of motion
Anticipate healing in 2 weeks
References
Clark (2003) Am Fam Physician 68:2167-76 [PubMed]
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