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SURGICAL MANAGEMENT OF
ACUTE INFECTIONS OF THE HAND
www.diuchirurgiemain.org
PLAN
• Physiology of infection
• Surgical treatment
• Anatomical spaces
and surgical
implications
Kanavel Allen B. An anatomical, experimental, and clinical study of acute phlegmons of the hand Q Bull Northwest Univ Med
Sch. 1906 March; 7(4): 384–446.
ACUTE INFECTION:
THE DIFFERENT PHASES
• Inflammation
• Infection
• Complication
ACUTE INFECTION:
THE DIFFERENT PHASES
• Inoculation:
• Inflammation:
• Antibiotics ?
• Infection
• Complication
• Inoculation:
• Inflammation:
• Infection:
• Complication
ACUTE INFECTION:
THE DIFFERENT PHASES
• Complication: = diffusion of
the infection into closed
spaces (joints, sheaths), bone,
anatomical spaces of diffusion
SURGICAL TREATMENT
• Urgent
• Bacteriological samples
SURGICAL TREATMENT
• Abundant lavage
• No « artificial »
drainage
SURGICAL TREATMENT
• Hand surelevation
• Starts rehabilitation if
needed as early as possible
Pierrart J et al. Acute felon and paronychia: Antibiotics not
necessary after surgical treatment. Prospective study of 46
patients. Hand Surg Rehabil. 2016 Feb;35(1):40-3.
ANATOMICAL SPACES: FINGER
• Pulp
• Perionychium
• Dorsal space
• Volar space
• May diffuse
• « Closed sac »
Hauck RM, et al. Pulp Nonfiction: Microscopic Anatomy of the Digital Pulp Space. Plast. Reconstr. Surg. 2004; 113: 536-539.
DORSAL DIFFUSION AT THE FINGER
• Index 5,1%
• Middle 4.0%,
• Annular 3.5%
• The sheath of II & III may arise from the radial sheath
• Two incisions
Phillips CS et al. The flexor synovial sheath anatomy of the little finger: a macroscopic study. J Hand Surg 1995;20A:636-641
• 50% of the little finger
sheaths end at the
level of the palmar
transverse ligament
Phillips CS et al. The flexor synovial sheath anatomy of the little finger: a macroscopic study. J Hand Surg 1995;20A:636-641
DIGITO-PALMAR SHEATHS
• Up to 85% of patients:
communication between
the radial, ulnar sheath and
the midpalmar space
DEEP SPACES OF THE HAND
• Thenar
• Mid-palmar
• Hypothenar:
• No possible expansion
• Mid-palmar
• Dorsal swelling
SURGICAL
CONSEQUENCES
• Limits are:
• Proximal: Flexor
superficialis muscles
• Dorsal: Pronator
quadratus and
interosseous membrane