Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA
Felon (Fingertip Pulp Infection)
Definition
- A felon is a localized abscess of the volar pulp of the fingertip
- Typically presents with:
- Pain
- Swelling
- Tenderness
Key Concept
- It is a compartmental infection of the fingertip pulp
Causes
- Usually due to direct bacterial inoculation
Common Causes
- Needle puncture injuries
- Splinters or thorns
- Minor penetrating trauma
Anatomy of Fingertip Pulp
- Pulp contains:
- Multiple small fat compartments
Structure
- Compartments separated by fibrous septa
Attachments
- Septa extend between:
- Dermis
- Distal phalanx
Clinical Significance
- Creates a closed space — pressure buildup during infection
Pathophysiology
- Infection leads to:
- Accumulation of pus in compartments
Resulting Effects
- Increased pressure
- Compression of blood vessels
- Reduced blood supply
Consequences
- Ischemia
- Tissue necrosis
Possible Complications
- Osteomyelitis (distal phalanx)
- Flexor tendon sheath infection
Clinical Insight
- Delay in treatment — serious deep infections
Common Organism
- Staphylococcus aureus infection
Treatment
Surgical Management (Primary Treatment)
- Incision and drainage (I&D)
Goals
- Release pus
- Reduce pressure
- Prevent necrosis
Important Surgical Step
- Break fibrous septa to:
- Decompress compartments
Structures to Protect
- Flexor tendon sheath
- Distal interphalangeal joint
Surgical Incision Options
When No Foreign Body
- Mid-axial incision
- J-shaped incision
Post-procedure
- Wound left open for:
- Continued drainage
When Foreign Body Present
- Longitudinal volar incision
- Allows:
- Removal of foreign body
- Adequate drainage
Incisions to Avoid
1. Fish-mouth incision
- Risk:
- Pulp instability
2. Double longitudinal incisions
- Risk:
- Injury to digital neurovascular bundles
Key Clinical Points
- Felon = compartment syndrome of fingertip pulp
- Early treatment prevents:
- Necrosis
- Deep spread of infection
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