Conditions That Cause Recurrence of Felons
Recurrence of felons is exceedingly rare when adequate surgical drainage is performed, with only 1 case of recurrence documented in 46 patients (2.2%), and that single failure was attributed to inadequate initial excision rather than any underlying medical condition. 1
Primary Cause of Recurrence
Inadequate surgical excision is the sole documented cause of felon recurrence. 1 The key to preventing recurrence is complete drainage of the abscess and thorough debridement of all necrotic tissue at the initial procedure. 1, 2, 3
- The single recurrence case in the prospective study of 46 patients occurred specifically because the initial surgical excision was incomplete. 1
- When proper surgical technique is used with complete drainage, healing occurs without complications in 98% of cases, even without postoperative antibiotics. 1
Risk Factors That May Predispose to Recurrence
While not directly proven to cause felon recurrence in the literature, certain immunosuppressive conditions theoretically increase infection risk and warrant more aggressive initial treatment:
Immunocompromised States
- Diabetes mellitus alters the intensity of bacterial action and requires more aggressive treatment approaches. 4
- Immunosuppressive therapy changes how organisms behave and may require extended antibiotic coverage after drainage. 4
- Patients with these conditions were specifically excluded from the study demonstrating low recurrence rates, suggesting they may be at higher risk. 1
Systemic Diseases
- Chronic kidney disease and other systemic illnesses must be considered as they alter the course of infection. 4
- These conditions may impair wound healing and local immune responses. 4
Critical Pitfall to Avoid
Do not attribute recurrence to inadequate antibiotic therapy—antibiotics play no role in preventing recurrence when adequate surgical drainage is performed. 1 The prospective study definitively showed that 45 of 46 patients healed completely without any postoperative antibiotics, with the single failure due to incomplete excision, not absence of antibiotics. 1
- Antibiotics should be reserved for patients with complications (arthritis, osteitis, flexor tenosynovitis, lymphangitis) or those who are immunosuppressed, diabetic, or have cardiac valve prostheses. 1
- Systematic antibiotic use after uncomplicated felon drainage is unnecessary and promotes antibiotic resistance. 1
Surgical Technique Considerations
The specific surgical approach matters for preventing recurrence:
- Longitudinal midvolar incision is preferred for superficial abscesses where most felons point. 2, 3
- Lateral incision is indicated for deep infections. 3
- The incision must not extend past the distal interphalangeal joint space. 3
- Always drain the abscess where it points, based on maximal tenderness location. 2