Purulent diseases of the fingers and hand

Panaritium



 * definition: purulent affection of the fingers
 * etiology: mainly staphylococci, less streptococci, fungi, erysipelothrix
 * cause: minor injuries, improperly treated


 * the back of the hand (except the nails) has an infection like elsewhere on the skin


 * specificity are classic panaricia of the volar side


 * the most common errors in therapy – postponement of surgery, incorrect localization of incisions, imperfect immobilization, inappropriate ATB, failure to perform X- ray

Panaritium subunguale

 * it is often caused by a forgeign body (chip)
 * there is a purulent deposit under the nail, swollen paraungual tissue, pain on pressure
 * treatment:


 * fenestration of the nail above the bearing, in larger ones – partial or total nail removal under seductive anesthesia
 * removal of necrosis, antiseptics , dressing, immobilization, finger baths

Panaritium cutaneum, subcutaneum, button-like

 * they affect the volar part of the finger, most often the distal joint
 * epidermoid (cutaneum) – purulent blister
 * pulpous (subcutaneum) – in the belly of the finger
 * button-shaped form – combines the two previous forms in the shape of a cufflink
 * significant throbbing pain, temperature, limited mobility of the finger, edema on the dorsum
 * therapy : incision from both sides

Panaritium tendineum, tendovaginosum, V-phlegmona

 * caused by: progression of subcutaneous panaritium or direct tendon injury
 * swelling of fingers with relief grip, pain when moving
 * due to the anatomical arrangement of the tendon sheaths, phlegmon can spread from the side of the little finger to the thumb, leaving out the middle space (so-called V-phlegmon)


 * sheaths of tendons 2.–4. the finger ends more distally…


 * treatment :


 * during hospitalization, in CA or LA (axillary block)
 * opening of the tendon sheath, repeated irrigations with a tube for several days
 * immobilization with a plaster bandage
 * treatment of native Panaricium
 * V-phlegmon – opening both spaces, cutting the retinaculum of the carpal tunnel to release the median

Panaritium osseum

 * it is usually a complication of poorly treated soft tissue panarises
 * in 2-3 weeks for X-ray – periosteal apposition, subperiosteal abscess, fusion of phalanx, sequestrations
 * the finger is swollen, painful
 * therapy :


 * incision dorsally, evacuation of pus, removal of sequestration, irrigation and application of ATB ointment
 * cast, ATB - several weeks, the regeneration capacity of the periosteum is considerable, there is no point in rushing with amputation

Panaritium articulare

 * restricts joint function
 * source: most often from the surroundings, less often in case of injury

Paronychium

 * definition: swelling and redness at the edge of the nail
 * treatment : incision in the sphincter LA, curettage, bandage with antiseptic, immobilization


 * removing the entire nail is usually unnecessary

Palm Panaritium

 * in the middle space (between the osteofascial space of thenar and hypothenar)
 * space is divided into ulnar (3rd and 4th MTC) and radial (2nd MTC) space
 * both spaces connect at the carpal tunnel and at the same time communicate with the forearm through the same channel - with Paron's space
 * source – follows on from an external injury
 * the gate of infection can be seen on the hand, redness, edema of the dorsum, pain on opposition of the thumb
 * treatment :


 * excision of a wound or bearing, wide opening of the space, while respecting the lines in the palm
 * long-term immobilization with a splint in a functional position (the splint goes up to the forearm, fingers in semiflexion, slight dorsiflexion in the wrist)

Deep phlegmon of the forearm ( Paron's space )

 * it can proceed as a life-threatening infection with manifestations of sepsis
 * anatomy of the space – it is an imaginary space, ventrally on the forearm (in the front group of muscles)


 * it is the space between the 3rd and 4th layer of the front group of muscles on the forearm, i.e. below all the flexors of the fingers and above the pronator quadratus and flexor digitorum profundus.

related articles

 * Panaricium
 * Paronychium

Source

 * BENEŠ, Jiří. Study materials  [online]. [feeling. 2010]. < http://jirben.wz.cz >.

Category:Surgery Category:Orthopedics