Skip to Main Content

++

A felon is a subcutaneous infection or abscess in the pulp space on the volar aspect surface of the distal phalanx. It is usually caused by penetrating trauma, an abrasion, or a minor cut with invasion of bacteria. A felon can also develop in the presence of a foreign body, such as a wood splinter or a thorn.1 It can be iatrogenic from multiple fingersticks for glucose determination.2 The offending organism is usually Staphylococcus aureus. Mixed infections and gram-negative infections may occur in the immunocompromised patient. A felon can less commonly occur on the toes. The information in this chapter can be applied to a felon of the finger or the toe.

++

Felons initially present with a gradual onset of pain and erythema in the distal finger. Intense throbbing pain, warmth, and swelling develop with the formation of an abscess as the infection progresses. The proper treatment for a felon is incision and drainage. There are multiple techniques to incise and drain a felon. The patient requires digital elevation, immobilization, oral antistaphylococcal antibiotics, oral analgesics, and close follow-up to prevent complications following the incision and drainage.3–7

++

The distal finger consists of a closed compartment that is bound by the nail plate dorsally, by the skin ventrally and distally, and by the flexion crease proximally (Figure 91-1). This pulp region is divided by multiple vertical septa.8 These septa extend from the volar surface of the fat pad to the periosteum of the distal phalanx. They divide and compartmentalize the pulp area. When an abscess occurs, it is confined by the septa. They also limit the proximal spread of an infection. Unfortunately, they also inhibit the abscess from reaching the surface and inhibit drainage after the incision and drainage procedure. Blood is supplied by branches of the digital arteries that run parallel and lateral to the phalanx and terminate in the pulp region. The terminal branches of the digital nerves lie palmer and superficial to the arteries. The flexor digitorum profundus tendon inserts on the volar surface of the proximal distal phalanx.

++
Figure 91-1
Graphic Jump Location

Midsagittal section demonstrating the anatomy of the distal finger.

++

All felons that are fluctuant should be incised and drained.

++

Felons that are not yet fluctuant, as in an early infection, may be treated with warm soaks, elevation, oral antibiotics, and follow-up in 24 hours.6,7 A herpetic whitlow can sometimes be confused with a felon.5,9 A herpetic whitlow can be clinically distinguished by the presence of multiple vesicles and a history of recurrence or simultaneous genital or oral lesions. Treatment of a herpetic whitlow is nonsurgical and consists of a protective dry dressing, oral antiviral agents, and analgesics. Incision and drainage of a herpetic whitlow may spread the virus and predispose the patient to secondary bacterial ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessEmergency Medicine Full Site: One-Year Subscription

Connect to the full suite of AccessEmergency Medicine content and resources including advanced 8th edition chapters of Tintinalli’s, high-quality procedural videos and images, interactive board review, an integrated drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessEmergency Medicine

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.