Chirurgische Therapie von Infektionen der Hand

Abstract

Due to its function, anatomy, and exposition to multiple pathogens, the hand is highly susceptible to infection. Most of these infections are post-traumatic. Isolates of pathogens from infected hands contain mainly Staphylococcus aureus and beta-hemolytic group A streptococci. We find Pasteurella canis and P. multocida from cat and dog bite wounds and Eikenella corrodens from human bite wounds. The "fight-bite clenched fist" wound, with penetration of the metacarpophalangeal joint and its high risk of septic arthritis, has always to be suspected when patients present with human bites. The therapy of hand infection is based on three principles: surgical treatment, adequate antimicrobial therapy, and early physiotherapy. Early infectious conditions of the hand, e.g. cellulitis and early paronychia, may be treated without surgery. Antimicrobial treatment must be specific for the pathogen and its resistance to antimicrobial agents. Bite wounds should be treated with beta-lactam antibiotics and beta-lactamase inhibitors. Staphylococci and streptococci can be covered by first and second generation cephalosporins. The increasing resistance of staphylococci to antibiotics has to be taken into account. Infections with anaerobic and gas-producing bacteria are rare but occur predominantly in diabetics and immune-compromised individuals.

Animal and Human Bite Wounds

“…Human bite wounds in the form of oval or semilunar hematomas and abrasions can be seen as the result of sexual crimes, child abuse, and physical altercations (so-called self-defense bites), or even consensual sexual activity (14,15). Indirect human "bite" wounds caused by a blow from the fist to another person's teeth have their own specific pattern of injury (known as reverse bite injury, clenched fist injury, or fight bite) (16)(17)(18)(19). Direct occlusion bites manifest a more or less distinct impression of the biter's teeth; in cases of suspected child abuse, for example, a bite by an adult can usually be reliably distinguished from one by a child (smaller radius, impressions of individual teeth, deciduous dentition).…”

“…Indirect wounds of the fist-against-teeth variety are typically accompanied by injury of the metacarpophalangeal joint capsules and proximal phalanges of the second through fifth fingers (16,18). Published classifications of the severity of bite wounds (28,29) are based on the degree of involvement of deeper-lying structures and on the presence or absence of vascular and peripheral nerve injury (Box 1, Table 1).…”

“…Infected bites are usually in soft tissues (mainly on the hands, but also the head and neck in small children) and thus present with cellulitis or a phlegmon with abscess formation and lymphadenopathy. Tenosynovitis and joint empyema are common in the hands (4,7,18,19,(24)(25)(26).…”

Tetanus following replantation of an amputated finger: a case report

“…Many cases of tetanus caused by minor traumas and gardening have been reported, and tetanus development is impossible to predict from the severity of the trauma [2-6]. However, it is possible to reduce the incidence by irrigation and debridement of the injured regions [6,7] because C. tetani adheres mainly to necrotizing tissue. In this patient, it is likely that the replanted middle finger only partially engrafted and that C. tetani colonized the partially necrotized region.…”

Die nekrotisierende Fasziitis an der Hand – Ein seltenes, hochdramatisches Krankheitsbild

“…Die plastische Defektdeckung erfolgte bei unseren beiden Patienten aufgrund der Gesamtsituation (hochseptisches Krankheitsbild, Alter, Komorbidit ä t) und des geringeren Operationsrisikos durch Spalthauttransplantationen nach vorheriger Wundkonditionierung mittels VAC-Therapie. Wahrscheinlich h ä tten aufwendigere operative Ma ß nahmen -gestielte oder mikrovaskul ä re Lappenplastiken -zu besseren funktionellen Ergebnissen gef ü hrt [18,19] . Solche schienen uns jedoch bei beiden multimorbiden Patienten zu riskant.…”