Felon involving the Hands

Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

FELON

• Felon  is an abscess of volar bulb of finger tip that can cause pain and swelling.
• It occurs from penetrating trauma such as needles or splinters.
• The bulb has  multiple small compartments of subcutaneous fat separated by septa between the dorsal phalanx(bone) and dermis.
• The volar  distal pulp is septated(multiple septa and multiple compartments).
• When infection occurs, there will be swelling and the pressure that is built inside of the compartment will lead to multiple little compartment syndromes.
• This will lead to vascular compromise and necrosis of the tissue. It also may lead  to osteomyelitis of bone or flexor tenosynovitis.
• Staphylococcal aureus is the most common organism.

Treatment

• Incision and drainage
• Do not violate the flexor tendon sheath or the DIP joint
• Try to break up the septa to decompress the infection.
• If there is no foreign body in the finger,  the mid axial incision or J shaped incision is done and leave the wound open.
• If there is foreign body present such as splinter or thorn,  volar longitudinal incision is done.
• Try to avoid fish mouth incision as it will lead to unstable finger pulp.
• Try to avoid doing the double longitudinal incision, it may lead to injury of neurovascular  bundle.