Surgical management
At least three quarters of hand infections presenting to hospitals require drainage. The details of individual treatments are dependent on the type of infection. Various 'rules' exist:
- incisions should be longitudinal. This avoids damage to digital nerves. The exception is the incision at a skin crease which should be oblique.
- local anaesthetic should not be injected into regions of infection due to the risk of spread and inactivation of the drug. Alternatives include:
- Bier's block
- digital block e.g. for paronychia
- wrist block e.g. for web space infection
- axillary block
- supraclavicular block
- general anaesthetic is an alternative if the patient has no significant systemic compromise
- the anaesthetic should permit the use of a bloodless field e.g. by tourniquet application
- to prevent collateral ligament contracture, the metacarpophalangeal joints should be immobilized at 90 degrees and the interphalangeal joints at 180 degrees
- in tenosynovitis, early physiotherapy is recommended
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