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Hand Infections

Arrangement of fascia and fascial septa in the hand is such that many spaces are formed. These spaces are of surgical important because they may become infected and distended with pus. Spaces are as follows:

  1. Palmar spaces
    - Pulp space of the fingers
    - Midpalmar space
    - Thenar space
  2. Dorsal spaces
    - Dorsal subcutaneous space
    - Dorsal subaponeurotic space
  3. The forearm space of Parona
  1. Pulp Space of Finger

Fig: The digital pulp space.



Tips of finger and thumb contain subcutaneous fat arranged and tight compartments formed by fibrous septa which pass from skin to the periosteum of the terminal phalanx.

  1. Infection of Pulp Spaces
    1. Infection of pulp spaces also known as FELON or WHITLOW.
    2. Caused by penetrating injury from a foreign body or from fingersticks: for medical reasons (e.g. hematocrit and blood sugar determination).
    3. Staph aureus is the commonest organism to cause this infection.
    4. Swelling redness, pain, typical of cellulitis initially are presented.
    5. The pulp abscess (felon) can extend into the periosteum, around the nail bed, or proximally through the periosteum, around the nail bed, or proximally through the fibrous curtain or through the skin to the exterior over the pulp.
      Treatment: Incision and Drainage
  2. Web Space Infection (Collar Button Abscess)
    Web space infection localizes in one of the three fat filled interdigital spaces just proximal to the superficial transverse ligament at the level of metacarpophalangeal joints. Infection begins beneath palmar calluses in labourers. It may begin near the palmer surface but because skin and fascia here are less yielding it may localize to drain dorsally.
  3. Mid Palmer and Thenar Space Infection

Fig: Fascial Spaces of Hand

  1. iMid palmer abscess can cause severe systemic reaction local pain and tenderness inability to move long and ring fingers because of pain and generalized swelling of hand and fingers which resemble and INFLATED GLOVE.
  2. iThenar abscess causes similar symptoms but thumb web is more swollen. The index finger is held flexed and active motion of both the index finger and thumb is impaired because of pain.
  1. Space of Parona
    1. This space is border by pronator quadratus dorsally, flexor pollicis longus laterally, flexor carpi ulnaris medially and flexor tendons on palmar aspect.
    2. Abscess of these spaces usually result from spread of infection from other parts of hand typically from purulent flexor tenosynovial infections.

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