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Felon L03.019 681.01

 

synonyms:

Felon ICD-10

Felon ICD-9

  • 681.01 Felon Pulp abscess whitlow  Excludes: herpetic whitlow (054.6)

Felon Etiology / Epidemiology / Natural History

  • Closed-space infections of the digitial pulp
  • Most commonly pathogens: Staph aureus

Felon Anatomy

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.
  • Irrigate.
  • Pack wound loosely with gauze.

Felon Associated Injuries / Differential Diagnosis

  • Cellulitis
  • Paronychia
  • Herpetic Whitlow
  • Flexor Tendon Tenosynovitis

Felon Complications

  • 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

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