What Is Chronic Felon Finger?
A chronic felon finger (also known as a felon) is a painful infection that occurs within the closed-space compartments of the fingertip pulp. This area is known as the distal digital pulp. The infection causes a pocket of puss or abscess within your fingertip that causes swelling and ultimately leads to intense throbbing pain. If the blood flow is reduced due to compression from edema and pus formation then the surrounding tissues are at risk for ischemia. If left untreated, the underlying bone, tendons, or joints can become infected. That is why felon fingers should be treated. Usually, the treatment involves oral antibiotics and incision, and drainage of the infected pulp space.(1, 2)
Surgical Management Of Chronic Felon Finger: An Overview
Doctors usually diagnose a felon finger by simply examining it. They might ask you whether you had an injury in the infected area. Some signs of a felon include redness, tenderness, firmness, and enlargement of the fingertip. If you have small bubble-like cysts on the skin and experience repeated episodes, it is likely caused due to herpetic whitlow.
In the early stage of felon finger infection (the felon is in the cellulitis stage), when abscess formation has not yet occurred, it can be usually treated with oral antibiotics like anti-staphylococcal and anti-streptococcal antibiotics. Sometimes, your doctor might also ask you to soak your infected finger in warm water and keep your finger elevated. However, once there is the formation of an abscess or pus (which is usually the later stage of infection), or in the case of a chronic felon finger, it requires surgical management. The surgical treatment includes incision and drainage should be performed to drain infected material and also maintain venous flow of blood to the finger. Since fibrous septae form multiple compartments, it could be difficult to drain a felon completely, and debridement in an operating room might be required.(3, 4, 5)
Preparation Before The Surgery for Felon Finger Infection
Before the Felon finger surgery begins, the patient is properly positioned, and the hand is cleansed and well-sanitized. The doctor will give the patient a pain-blocking medication or anesthetic to numb the finger or to make the patient fall asleep during the surgical procedure.
Draining The Felon Finger
The doctor or surgeon will make an incision to access and expose the infected area. Generally, the incision is made either on the underside of the finger over the point of maximum swelling or on the side of the infected finger.
The pus is drained by opening up the infected chambers, then dead skin or tissue is removed, and the wound is irrigated.
End Procedure Of The Felon Finger Surgery
The wound can be held open with a small rubber drain or loosely packed with gauze, and a bandage is applied.
Until the wound gets healed, the patient should soak the finger at least two to three times a day in a solution of hydrogen peroxide, soapy, or saline water. Generally, most patients heal completely within three to four weeks of the treatment.
NOTE: In certain cases, hand therapy might be required after healing because of scar sensitivity.
Prognosis Of Chronic Felon Finger
The prognosis is great and complications are rare and generally be prevented with early and prompt diagnosis and treatment.
The prime purpose of surgical management of chronic felon fingers is to drain the pus and relieve the pain, swelling, and pressure. If you think that you might have a felon finger infection that could turn chronic, you should see your doctor immediately without delay.
- Koshy JC, Bell B. Hand Infections. J Hand Surg Am. 2019 Jan;44(1):46-54. [PubMed]
- Blumberg G, Long B, Koyfman A. Clinical Mimics: An Emergency Medicine-Focused Review of Cellulitis Mimics. J Emerg Med. 2017 Oct;53(4):475-484. [PubMed]
- Patel DB, Emmanuel NB, Stevanovic MV, Matcuk GR, Gottsegen CJ, Forrester DM, White EA. Hand infections: anatomy, types and spread of infection, imaging findings, and treatment options. Radiographics. 2014 Nov-Dec;34(7):1968-86. [PubMed]
- Hijjawi JB, Dennison DG. Acute felon as a complication of systemic paclitaxel therapy: case report and review of the literature. Hand (N Y). 2007 Sep;2(3):101-3. [PMC free article] [PubMed]
- Shmerling RH. Finger pain. Prim Care. 1988 Dec;15(4):751-66. [PubMed]