Surgery and Healing in the Developing World - Dartmouth-Hitchcock

35
368 Surgery and Healing in the Developing World
Figure 11. Excision of chronic breast sinus
and infected duct.
Hand
Hand infections may cause disastrous disability if they are not adequately and
quickly treated.
Fingers
Infections under and around the fingernail may require excision of part or all of
the nail. Infections in the pulp space (felon or whitlow) should be drained with
lateral incisions and not through the palmar surface of the finger-tip to avoid tender
scars in the sensitive surface of the finger. The incision should be in the dorsal half of
the finger to avoid the digital nerve and should avoid contact with the bone (Fig.
12). An abscesses in the tendon sheath of a finger is called “tenosynovitis”. It produces
severe swelling of the finger. The finger is in a semi-flexed position and cannot
be flexed or extended without severe pain (Fig. 13). There is tenderness at the base
of the finger in the palm. Incisions to drain tendon sheath abscesses should be made
on each side of the finger between the joints at the ends of the finger creases (Fig.
13).
Deep Hand Abscesses
Most hand abscesses occur in the superficial or deep palmar spaces which surround
the tendons in the hand (Fig. 14). The first manifestation of palmar abscess
may be swelling on the dorsum of the hand. When the back of hand swells in a
painful hand, consider the likelihood of palmar space infection. Incisions to drain
Figure 12. Incision for draining pulp-space
abscess (felon).