New Incision for Closed Space Infection (Felon) Involving Distal Phalanx of Finger

Abstract

FELONS are among the most common infections of the distal phalanx. The ordinary conception of the pathogenesis of bone felons is Roux's theory, in which he claims that the lymphatic vessels run perpendicular from the skin to the periosteum, which is lifted off the bone and necrosis of the bone ensues. Against this assumption is the very firm attachment of the periosteum to the bone. Kanavel1 contends that pressure of the edema or pus in closed space infections shuts off the blood supply to the bone and causes necrosis. The epiphysis receives a separate blood supply and is, therefore, not involved in early cases.In reviewing the literature on incisions for closed space infections, the three most commonly employed are: (A) The midline; (B) fish-mouth; and (C) lateral hockey-stick. Mason,2 in his article on infection of the hand, makes the following comments relative to incisions for felons:(A) A midline incision for felon does not divide the perpendicular connective tissue fibers which attach the skin to the periosteum; the division of which is the essential feature of the operation for drainage of anterior space infections. (B) A fish-mouth incision, while it provides efficient drainage, is followed by a deep furrowed scar which seriously interferes with the use of the finger-tip for the performance of fine acts. Koch3 has also observed that the fish-mouth incision is unduly long in healing and leaves a painful scar over the finger-tip, and also an anesthetic area distal to the scar, which is annoying to anyone attempting to perform delicate manipulations.(C) The lateral hockey-stick type of incision fulfills the purpose of adequate drainage and does not leave any disabling scars, but does interfere with tactile sensation.It is with these facts in mind that a new incision is presented, which has been employed for closed space infections, which appears to eliminate theobjectionable features of the other incisions. The five illustrations shown in

Three Distinct Episodes of Thumb Felon in a Fur Industry Worker

“…The accumulation of pus causes swelling, redness, an early severe throbbing pain and may lead to skin necrosis, acute tenosynovitis, osteomyelitis and, even, septic arthritis. A felon with an abscess formation is treated surgically with drainage, irrigation and debridement as well as with the use of systemic antibiotics [1,2,3,4,5].…”