Overview of hand infections
- Sandeep Sebastin, MMed, FAMS
Sandeep Sebastin, MMed, FAMS
- Senior Consultant, Department of Hand & Reconstructive Microsurgery
- National University Hospital, Singapore
- Kevin C Chung, MD, MS
Kevin C Chung, MD, MS
- Chief of Hand Surgery
- Charles B.G de Nancrede Professor of Surgery
- University of Michigan Health System
- Shimpei Ono, MD, PhD
Shimpei Ono, MD, PhD
- Assistant Professor
- Department of Plastic, Reconstructive, and Aesthetic Surgery
- Nippon Medical School
- Section Editors
- Charles E Butler, MD, FACS
Charles E Butler, MD, FACS
- Section Editor — Plastic and Reconstructive Surgery
- The University of Texas, MD Anderson Cancer Center
- Marc G Jeschke, MD, PhD
Marc G Jeschke, MD, PhD
- Section Editor — Burn Surgery
- Director Ross Tilley Burn Centre
- Sunnybrook Health Sciences Centre
- Professor, Department of Surgery and Plastic Surgery
- University of Toronto
The majority of patients with acute hand infections are healthy and active young adults who neglect treatment for minor trauma; more severe infections are seen in patients with impaired immune status.
The initial evaluation and management of hand infection includes a focused history and examination and often involves laboratory evaluation and imaging. The area of erythema should be marked to help document progression of the infection. Empiric antibiotics should be started. Elevation of the hand and arm and application of a heat pack, along with appropriate pain control, will decrease swelling and provide comfort.
Deep hand infections are surgical emergencies. Prompt evaluation and proper treatment of hand infections can mean the difference between an excellent outcome and permanent disability.
The basic principles of evaluating and treating hand infections and considerations for specific hand infections are reviewed here. An overview of the evaluation of hand pain is discussed separately. (See "History and examination of the adult with hand pain".)
The general principles of evaluating and treating hand infections are outlined in the next few paragraphs. The specific management of bite wounds, superficial hand infections, and deep space infections are reviewed below. (See 'Bite wounds' below and 'Superficial hand infections' below and 'Deep infections' below.)
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- GENERAL PRINCIPLES
- History and physical
- Laboratory studies
- Diagnosis and further evaluation
- - Imaging
- - Cultures
- Differential diagnosis
- - Antibiotic therapy
- - Tetanus prophylaxis
- - Splinting
- - Elevation
- - Heat
- BITE WOUNDS
- Animal bites
- Human bites
- SUPERFICIAL HAND INFECTIONS
- Pulp space infections
- Herpetic whitlow
- Subcutaneous abscess
- Web space abscess
- DEEP INFECTIONS
- Synovial space infections
- Deep fascial space infections
- Septic arthritis
- Necrotizing fasciitis
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS