From the Guidelines
Management of a felon (infection of the fingertip pulp) requires prompt incision and drainage as the primary treatment, along with empiric antibiotic therapy that covers Staphylococcus aureus and streptococci, as recommended by the 2018 WSES/SIS-E consensus conference 1. The primary goal of treatment is to prevent morbidity, mortality, and improve quality of life by reducing the risk of complications such as osteomyelitis, sepsis, and permanent functional impairment. Key considerations in the management of a felon include:
- Incision and drainage of the abscess, which is the primary treatment for simple abscesses or boils, as recommended by the 2018 WSES/SIS-E consensus conference 1
- Empiric antibiotic therapy with medications that cover Staphylococcus aureus, such as cephalexin 500mg four times daily for 7-10 days or clindamycin 300mg four times daily for patients with penicillin allergy
- Coverage for MRSA, if suspected, with vancomycin or another antimicrobial effective against both MRSA and streptococci, as recommended by the 2014 IDSA guidelines 1
- Elevation of the affected hand and change of dressings daily until the wound heals by secondary intention
- Pain management with acetaminophen or NSAIDs, as needed
- Tetanus prophylaxis, if the patient's immunization status is not current
- Hand therapy exercises, after the acute infection resolves, to prevent stiffness and maintain function. It is essential to note that the management of a felon requires aggressive treatment due to the complex anatomy of the hand, which allows infections to spread rapidly through tendon sheaths and deep spaces, potentially leading to permanent functional impairment if not properly managed.
From the Research
Management of a Felon (Infection of the Fingertip Pulp)
- A felon is a type of abscess that occurs on the fingertip pulp, which is a sensitive area with limited space for swelling [(2,3,4)].
- The management of a felon typically involves incision and drainage, as this is the most effective way to relieve pressure and promote healing [(2,3,4)].
- Antibiotics may be prescribed in some cases, but they are not always necessary and should be chosen based on the suspected causative organism [(5,6,3)].
- The choice of antibiotic should take into account the possibility of methicillin-resistant Staphylococcus aureus (MRSA), which is a common cause of skin and soft tissue infections [(5,6,3)].
- Minocycline may be a preferred option for the treatment of uncomplicated community-acquired MRSA skin and soft-tissue infections, including felons 5.
- Loop drainage is a preferred technique over traditional incision and drainage for the treatment of abscesses, including felons 4.
- Most patients with felons can be managed as outpatients, but some may require hospitalization if the infection is severe or if there are signs of systemic illness [(3,4)].