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Acute finger-tip infection: Management and treatment. A 103-case series - 16/09/17

Doi : 10.1016/j.otsr.2017.03.024 
F. Rabarin , J. Jeudy, B. Cesari, A. Petit, N. Bigorre, Y. Saint-Cast, P.-A. Fouque, G. Raimbeau
the

Orthopedics and Traumatology Society of Western France (SOO)1

  Article issued from the SOO (the Orthopedics and traumatology society of Western France).

 Centre de la main, chirurgie de la main, 47, rue de la Foucaudière, 49800 Trélaze, France 

Corresponding author.

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Abstract

Introduction

Acute fingertip infections (AFTI) are common. Surgical treatment is the norm in case of effusion. There is, however, no consensus on treatment modalities, or on adjuvant antibiotic therapy (AT). We present the results of a consecutive cohort of 103 AFTIs treated in emergency consultation.

Materials and method

One hundred and one patients were treated by excision and extensive lavage under digital anesthesia, with systematic bacteriological sampling. Patient history, treatment history, location, type of bacteria, complications or recurrences and AT prescription were recorded and analyzed. All patients were reviewed at first dressing (5–7 days) and recontacted at 1 month, to record any pain, stiffness or recurrence. Three groups were distinguished: A: without preoperative AT (n=71); B: under AT before surgery (n=14); C: with postoperative AT (for severe comorbidity) (n=16).

Results

Mean age was 39.7 years (range: 14–84 years). The three main types of bacteria were: Staphylococcus aureus (58.3%), polymicrobial flora (16.5%), and Streptococcus (12.6%). Mean time to first dressing was 5.7 days. There were no recurrences, whatever the bacterial type or patient group. In 5 patients in group A (8.2%), AT was later prescribed at day 5 (3 for hypercicatrization and 2 for maceration). In groups B and C, progression was unproblematic. At 1 month, all patients considered themselves cured; finger-tip sensitivity was conserved in 10, and 16 were awaiting complete nail regrowth.

Discussion

Hospital admission, operative treatment under general anesthesia, and AT are factors exacerbating cost and increase the management burden of AFTI. Treatment in emergency consultation seems perfectly feasible. AT does not seem useful in the absence of severe comorbidities if resection is complete. Analysis of bacterial susceptibility and renewal of the initial dressing at 1 week enable progression to be monitored and treatment changed as necessary.

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Keywords : Felon, Finger-tip infection, Antibiotic therapy, Paronychia


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 Article issued from the SOO (the Orthopedics and Traumatology Society of Western France).


© 2017  Elsevier Masson SAS. Reservados todos los derechos.
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Vol 103 - N° 6

P. 933-936 - octobre 2017 Regresar al número
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