eMedicine Specialties > Emergency Medicine > Infectious Diseases

Felon: Follow-up

Author: Glen Vaughn, MD, Director, Department of Emergency Medicine, Defiance Hospital
Contributor Information and Disclosures

Updated: Oct 1, 2009

Follow-up

Further Outpatient Care

  • Splint and elevate finger.
  • Provide follow-up care within 2 days.
  • Remove packing in 2 days.

Complications

  • Osteomyelitis involving the diaphysis of distal phalanx is a common complication.
  • The most serious complication is acute tenosynovitis, which may result from contiguous spread of infection. This is usually iatrogenic from inadvertent nicking of flexor tendon sheath with scalpel.
  • Other complications include skin necrosis, deformity of the fingertip, septic arthritis, and instability of the finger pad.

Prognosis

  • Prognosis is excellent when treated early and appropriately.

Miscellaneous

Medicolegal Pitfalls

  • Failure to adequately treat infection can result in serious complications.
  • Failure to check pressure and accumulation of pus in a closed compartment may lead to osteomyelitis and skin necrosis.
  • Failure to perform judicious incisions may result in unstable tender fingertips or flexion contractures of DIP flexor crease.
  • Failure to address the possibility of methicillin-resistant S aureus may result in worsening infection.

Special Concerns

  • Instability of distal phalangeal skin and fat pad is a significant handicap that has resulted from traditional insistence on division of septa.
 


More on Felon

Overview: Felon
Differential Diagnoses & Workup: Felon
Treatment & Medication: Felon
Follow-up: Felon
Multimedia: Felon
References
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References

  1. Connolly B, Johnstone F, Gerlinger T, Puttler E. Methicillin-resistant Staphylococcus aureus in a finger felon. J Hand Surg [Am]. Jan 2000;25(1):173-5. [Medline].

  2. Barkin JA, Miki RA, Mahmood Z, Landy DC, Owens P. Prevalence of methicillin resistant Staphylococcus aureus in upper extremity soft tissue infections at jackson memorial hospital, miami-dade county, Florida. Iowa Orthop J. 2009;29:67-73. [Medline].

  3. Pallin DJ, Egan DJ, Pelletier AJ, Espinola JA, Hooper DC, Camargo CA Jr. Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus. Ann Emerg Med. Mar 2008;51(3):291-8. [Medline].

  4. Newfield RS, Vargas I, Huma Z. Eikenella corrodens infections. Case report in two adolescent females with IDDM. Diabetes Care. Sep 1996;19(9):1011-3. [Medline].

  5. Glickel SZ. Hand infections in patients with acquired immunodeficiency syndrome. J Hand Surg [Am]. Sep 1988;13(5):770-5. [Medline].

  6. Bolton H, Fowler PJ, Jepson RP. Natural history and treatment of pulp space infection and osteomyelitis of the terminal phalanx. J Bone Joint Surg. 1949;4:499-504.

  7. Canales FL, Newmeyer WL, Kilgore ES. The treatment of felons and paronychias. Hand Clin. Nov 1989;5(4):515-23. [Medline].

  8. Clark DC. Common acute hand infections. Am Fam Physician. Dec 1 2003;68(11):2167-76. [Medline].

  9. Elston DM. Optimal antibacterial treatment of uncomplicated skin and skin structure infections: applying a novel treatment algorithm. J Drugs Dermatol. Nov-Dec 2005;4(6 Suppl):s15-9. [Medline].

  10. Hijjawi JB, Dennison DG. Acute felon as a complication of systemic paclitaxel therapy: case report and review of the literature. Hand (N Y). Sep 2007;2(3):101-3. [Medline].

  11. Kilgore ES Jr, Brown LG, Newmeyer WL. Treatment of felons. Am J Surg. Aug 1975;130(2):194-8. [Medline].

  12. Perry AW, Gottlieb LJ, Zachary LS, Krizek TJ. Fingerstick felons. Ann Plast Surg. Mar 1988;20(3):249-51. [Medline].

  13. Roberge RJ, Weinstein D, Thimons MM. Perionychial infections associated with sculptured nails. Am J Emerg Med. Oct 1999;17(6):581-2. [Medline].

  14. Watson PA, Jebson PJ. The natural history of the neglected felon. Iowa Orthop J. 1996;16:164-6. [Medline].

  15. Zyluk A, Puchalski P. [Severe infections within the upper extremity--analysis of the causes and methods of treatment]. Chir Narzadow Ruchu Ortop Pol. 2006;71(4):239-44. [Medline].

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Further Reading

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Keywords

felon, paronychia, fingertip infection, finger infection, closed-space infections, fingertip pulp, paronychias, hand infections, osteomyelitis, tenosynovitis, septic arthritis, Staphylococcus aureus, S aureus, Eikenella corrodens, E corrodens, wood splinter, minor cut, cellulitis, skin necrosis 

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Contributor Information and Disclosures

Author

Glen Vaughn, MD, Director, Department of Emergency Medicine, Defiance Hospital
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey Glenn Bowman, MD, MS, Consulting Staff, Highfield MRI, Columbus, Ohio
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jon Mark Hirshon, MD, MPH, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine
Jon Mark Hirshon, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

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