Felon

Felon

A felon is an abscess of the volar bulb of the finger tip that can cause pain and swelling. It occurs from penetrating trauma such as needles or splinters. The bulb has multiple, small compartments of subcutaneous fat, separated by septi between the dorsal phalanx (bone) and the dermis. The volar distal pulp is septated (multiple septum’s and multiple compartments). When pus occurs, there will be swelling, and the pressure that is built inside of the compartment will lead to multiple, little compartment syndromes. This will lead to vascular compromise and necrosis of the tissue. It also may lead to osteomyelitis of the bone or flexor tenosynovitis. Staphylococcus aureus is the most common organism. It can be treated with incision and drainage. Do not violate the flexor tendon sheath or the DIP joint. Try to break up the septi to decompress the infection. If there is no foreign body in the finger, you will do the midaxial incision or the “J shaped” incision, and you will leave the wound open. If there is a foreign body present, such as a splinter or a thorn, you will do the volar longitudinal incision. Try to avoid doing the “fish mouth” incision, it will lead to unstable finger pulp. Try to avoid doing the double longitudinal incision, it may lead to injury of the neurovascular bundle.