Felon Etiology / Epidemiology / Natural History
- Closed-space infections of the digitial pulp
- Most commonly pathogens: Staph aureus
Felon Clinical Evaluation
- Intense throgging pain and swelling of the entire finger pulp. Usually associated with penetrating trauma
Felon Xray / Diagnositc Tests
- A/P and lateral of affected digit. Usually normal, but indicated to rule out foreign body and osteomyelitis.
Felon Classification / Treatment
- Acute: if identify early a short trial of PO antibiotics, elevation and betadine soaks is indicated as long as not fluctuance is identified. Dicloxacillin 500 mg PO q6h, or Nafcillin 1-2 g IV q4-6h, or Clindamycin 300 mg PO q6h, or Cephalexin 500 mg PO q6h, or Cefazolin 1 g IV q8h, or Erythromycin 500 mg PO q6h
- MRSA is becoming increaseingly prevalent, especially in hand infections. Consider Bactrim DS +/- rifampin. If group A streptococcus is strongly suspected add Keflex
- Subacute / Chronic: any felon with abcess formation of the fails to improve with non-operative treatment should undergo incision and drainage.
Felon Felon I&D Technique
- Digital block.
- Prep and drape in standard sterile fashion.
- Midvolar or high lateral longitudinal incision based on area of fluctuance or maximal tenderness.
- Take anaerobic, aerobic cultures and gram stain.
- Use curved hemstat to break-up and loculations. Avoid deep proximal probing to prevent comtanination of the flexor tendon sheath.
- Pack wound loosely with gauze.
Felon Associated Injuries / Differential Diagnosis
- Vascular compromise with digital tip necrosis.
- Osteomyelitis of the distal phalanx
- Flexor tendon tenosynovitis
Felon Follow-up Care
- The finger is evaluated daily with BID dressing changes and betadine soaks.
- Wound evantually closes by secondary intention.
Felon Review References