HAND ABSCESS SEMINAR.pptx

Seminar on hand abscess

1. HAND ABSCESS PRESENTED BY: DR. TAYYABA AFREEN Reg No. 17M4618

2. Surgical Anatomy of the Hand Spaces of hand These are formed by fascia and fascial septae. Fascia and fascial septae of the hand are arranged in such a manner that many spaces are formed. These spaces are important as they can get infected and distended with pus . Spaces of hand

3. Important spaces of the hand are : Palmar Spaces Pulp space of fingers. Midpalmar space Thenar space Dorsal Spaces Dorsal subcutaneous space Dorsal subaponeurotic space The Forearm Space of Parona

4. Blood Supply of the Hand: Superficial palmar arch formed by ulnar artery. Deep palmar arch is formed by radial artery . Nerve Supply: Abductor pollicis brevis , flexor pollicis brevis , opponens pollicis and 1st and 2nd lumbricals are supplied by median nerve (5 muscles ). Rest of the muscles in hand are supplied by ulnar nerve (15 muscles).

5. PARONYCHIA It means infection of the lateral nail fold. It is the commonest type of hand infection . If the infection extends to the eponychium it is termed as “ E ponychia”. When the infection involves both lateral nail folds and eponychium it is called R un-around infection (Paronychia). In adults staphylococcus aureus is the most common pathogen. There are two types of paronychia, acute and chronic. Paronychia showing pointing pus.

6. Acute paronychia It occurs due to trimming of the nail or ingrowing nail . Risk factors : Hang nails, manicures, penetrating trauma, nail bitting or sucking. Clinical features : Initial swelling, erythema, tenderness with progression to fluctuance, and abscess formation typical. Spontaneous decompression can occur, including tracking beneath the nail plate. Deeper infections can involve the nail bed destruction, felon.

7. Treatment: Early cases (before formation of pus) can be managed by soaking, elevation, antibiotics and immobilisation. Surgical decompression is the treatment of choice.

8. Chronic paronychia Chronic paronychia occurs more commonly in individuals constantly exposed to moist environment. It is due to fungal infection moniliasis or due to candida infections. It produces a dull nagging pain in the fingers. The eponychium is faintly pink and nail is ridged . Treatment: Antifungal agents such as nystatin or tolnaftate solution helps the patient.

9. FELON Felon is deep space infection or abscess of the distal pulp of the finger or thumb. It is the second most common hand infection(25 %). Index and thumb are commonly affected. Usually by a minor injury like finger prick . Bacteria: Staphylococcus— most common. Streptococcus , Gram-negative organisms . Abscess(Felon)

10. Clinical Features : Fever. Tender axillary lymph nodes. Often suppuration is severe, forming collar stud abscess which eventually may burst Pain, tenderness, swelling in the terminal phalanx. Treatment Incision and drainage under digital block Volar longitudinal incision.

11. APICAL SUBUNGUAL INFECTION It is infection of the space between subungual epithelium and the periosteum . It occurs after minor trauma or rarely after formation of subungual haematoma . Excruciating tenderness with small visible pus under the tip (summit ) of the nail is the feature. Drainage with ‘V’ incision over the summit is the treatment along with antibiotics. APICAL SUBUNGUAL INFECTION

12. Clinical Features: Pain and swelling of palm in the region of web space. Extremely tender and hot swelling . Finger separation sign : Adjacent fingers are separated due to oedema. Gross oedema of the dorsum of hand. If untreated, pus from one web space can spread to the other web space and to the other proximal volar space.

13. Treatment: Under anaesthesia, a transverse skin incision is made and the pus is drained. The skin edge is trimmed in such a way as to leave a diamond-shaped opening to get better drainage .

14. DEEP PALMAR ABSCESS Two deep palmar spaces are present Midpalmar space. Thenar space. Infection of midpalmar space results in deep palmar abscess . Causes: Penetrating injuries Haematoma Suppurative tenosynovitis Clinical features Obliteration of normal concavity of the palm Gross oedema of the dorsum of the hand Extreme tenderness in midpalmar space MP joint movements are painful. IP (interphalangeal) joint movements are not painful.

15. Treatment: Elevation of affected limb. Antibiotics and analgesics. Drainage: Under anaesthesia, a transverse crease incision is made and once the palmar aponeurosis is seen, it is split longitudinally in the direction of the fibres to avoid damage to nerves and vessels .

16. ACUTE SUPPURATING TENOSYNOVITIS It is the bacterial infection of flexor tendon sheaths . Clinical features: The patient gives history of pricking type of injuries. Symmetrical, fusiform painful enlargement of finger. Flexed , fixed finger -'Hook sign’. IP joint movements are very painful: Severe pain on passive finger extension. MP joint movements are not painful: This sign differentiates suppurating tenosynovitis from deep palmar abscess . When there is infection of ulnar bursa, the maximum tender spot is in between the two palmar creases. This sign is described as ' Kanavel's sign'.

17. Treatment: Elevation of the affected limb. Antibiotics and analgesics. Position of rest. Drainage under general anaesthesia. Incisions are placed over the site of maximum tenderness and flexor sheath should be opened up. Many a times multiple incisions are required. SUPPURATING TENOSYNOVITIS

18. Herpetic Whitlow Herpetic Whitlow is an intensely painful infection of the hand involving one or more fingers that typically affects the terminal phalanx . Commonly involves thumb and index finger. Risk factors: Genital herpes in self or partner. Health care worker. Children with gingivostomatitis . Fig: Herpetic Whitlow

19. Clinical features: Localised pain, pruritus and swelling followed by the appearance of clear vesicles. Typically localised to one finger only. In latest stages coalescene of vesicles to form an ulcer . Treatment : Self limited disease. Incision is contraindicated as it spreads the infection may lead to herpetic encephalitis. Unroofing relieves the pain. Tropical antifungals can be applied .

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