Surgical management

At least three quarters of hand infections presenting to hospitals require drainage. The details of individual treatments are dependent on the type of infection. Various 'rules' exist:

• incisions should be longitudinal. This avoids damage to digital nerves. The exception is the incision at a skin crease which should be oblique.
• local anaesthetic should not be injected into regions of infection due to the risk of spread and inactivation of the drug. Alternatives include:
  • Bier's block
  • digital block e.g. for paronychia
  • wrist block e.g. for web space infection
  • axillary block
  • supraclavicular block
• general anaesthetic is an alternative if the patient has no significant systemic compromise
• the anaesthetic should permit the use of a bloodless field e.g. by tourniquet application
• to prevent collateral ligament contracture, the metacarpophalangeal joints should be immobilized at 90 degrees and the interphalangeal joints at 180 degrees
• in tenosynovitis, early physiotherapy is recommended