Felon Incision and Drainage

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A quick review of a digital block of the thumb and incision and drainage of a felon — an infection of the pulp of the finger. We use a unilateral longitudinal approach for our incision. Just one cut on the side of the finger! The distal pulp of the finger has multiple fibrous septa that need to be broken up to drain the infection adequately.

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Jeff B. -

No packing or drain?

Jess Mason -

Not in this technique, although it is perfectly acceptable to leave packing or a drain as well.

Greg M. -

Awesome video. I think I’m going to start saying “donesies” when I finish procedures now because it sounds so cool.

Luke M. -

I haven't had the pleasure of draining many felons. Splinting/antibiotics post procedure or follow up with plastics post procedure?

Jess Mason -

I give antibiotics, admit, and have the hand surgeon see them next day. A splint might help decrease pain.

Maxim BY, MDCM, FRCP-EM/PEM -

Great video - albeit very emetogenic!
One thing is of critcism though, i teach to incise those away from opposing finger/hand structures. I.e. if the thumb needs to be excised, then i'd incise on the radial side, because the ulnar side has more touch sensitive nerve endings you need for opposition and fine motor control.

or if the index needs to be incised then I'd go on the ulnar side, since the radial side opposed the thumb and you want to preserve those nerve endings.

Jess Mason -

I like that tip, all things being equal. Otherwise, go for the juiciest part.

Emergency NP -

Great video ,
1. Do you often collect pus swab for culture sensitivity ?

Jess Mason -

I generally assume that it's MRSA and cover for that, so I don't typically send cultures.

Mike R. -

Are there any draw backs to going through to both sides? Obviously a little more invasive

Facundo G. -

There seems to be a higher risk for neurovascular compromise. There is also the fish mouth approach that can also lead to an unstable thumb pulp.

The J approach used on the video is usually recommended.

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