Hand infections

Superficial infections include paronychia, cellulitis and lymphangitis. Grave infections include felon, purulent tenosynovitis, thenar infections, septic arthritis and human bites. Treatment by incision and drainage, moist heat, elevation, splinting and specific antibiotics or other agents applies to most hand infections. When pus is found, adequate drainage usually gives good results. Without drainage, pressure necrosis and gangrene often follow. Rest for the infected part and for the patient is as important as any other facet of treatment.

[Paronychia, the general practitioner, the surgeon and antibiotics (author's transl)]

Antibiotic therapy for paronychia has seen its day. It is indicated only rarely and justified only when on the day following infection or during the next few days there are signs of regional or systemic spread. The surgical treatment of infections of the hand is not difficult but should be known, if not learned. A paronychia which has been opened but not cured should be reoperated upon rapidly. An "old" paronychia is a major catastrophe: small fistula, great damage. No surgical quarter for evil organisms!

Surgical cure of chronic paronychia by eponychial marsupialization

A simple surgical procedure is presented which has been effective in curing the troublesome chronic paronychia. The anatomy and pathophysiology of this condition are discussed briefly.

Infections of the hand

In this paper the importance is stressed of the dangers associated with neglecting hand infections in Paua New Guinea, where, for understandable reasons, there is a tendency for people to be slow in seeking treatment. The prevention of hand infections is emphasised, and the principles in regard to rest, antibiotic therapy, and surgical decompression are discussed. The more common types of hand infection are described, with particular reference to surgical anatomy and surgical drainage. Some of the more complicated infections such as middle palmar and thenar space infections, suppurative tenosynovitis, osteomyelitis and septic arthritis are of sufficient importance to warrant the attentions of the specialist surgeon when this is possible.