Infections of the web space account for 4% of hand infections presenting to hospitals. Suppuration can spread along the volar aspect of related fingers or to adjacent web spaces across the anterior aspect of the palm. The usual infecting organism is Staphylococcus via a perforating injury.
Clinically, the patient will present with swollen, flexed and abbducted fingers, pain and swelling over the affected space.
The treatment is surgical drainage in conjunction with anti-Staphylococcal antibiotics. An approach via an adjacent skin crease is recommended, as postoperative web space contracture can occur. Pus should be cultured and antibiotics modified according to sensitivity.
Alternatively, careful longitudinal incisions into both palmar and dorsal surfaces of the space may be carried out. It should be combined with rigorous post-operative physiotherapy. Packing the wound open may assist the early stages of physiotherapy.
Last reviewed 01/2018