Hand Infections

      Infections are common in hand surgery and proper management is important to achieve optimal outcomes. Although most cases are not urgent, less common, severe infections such as flexor tenosynovitis and necrotizing fasciitis require urgent identification with both medical and surgical management. It is common for diagnoses to be missed or delayed because clinical and laboratory indicators are often variably present. Delayed identification and management can result in poor outcomes with permanent deficits. This article will provide a review of hand infections with a focus on identifying serious hand infections requiring urgent or emergent treatment, and distinguishing these from less urgent scenarios.

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      1. Centers for Disease Control and Prevention. Necrotizing fasciitis. Available at: https://www.cdc.gov/features/necrotizingfasciitis/index.html. Accessed Nov 12, 2017.

        • Anaya D.A.
        • McMahon K.
        • Nathens A.B.
        • Sullivan S.R.
        • Foy H.
        • Bulger E.
        Predictors of mortality and limb loss in necrotizing soft tissue infections.
        Arch Surg. 2005; 140: 151-157
        • Psoinos C.M.
        • Flahive J.M.
        • Shaw J.J.
        • et al.
        Contemporary trends in necrotizing soft-tissue infections in the United States.
        Surgery. 2013; 153: 819-827
        • Chan T.
        • Yaghoubian A.
        • Rosing D.
        • Kaji A.
        • de Virgilio C.
        Low sensitivity of physical examination findings in necrotizing soft tissue infection is improved with laboratory values: a prospective study.
        Am J Surg. 2008; 196 (discussion 930): 926-930
        • Wong C.H.
        • Khin L.W.
        • Heng K.S.
        • et al.
        The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections.
        Crit Care Med. 2004; 32: 1535-1541
        • Huang K.C.
        • Hsieh P.H.
        • Huang K.C.
        • Tsai Y.H.
        Vibrio necrotizing soft-tissue infection of the upper extremity: factors predictive of amputation and death.
        J Infect. 2008; 57: 290-297
        • Tsai Y.H.
        • Hsu R.W.
        • Huang K.C.
        • Huang T.J.
        Laboratory indicators for early detection and surgical treatment of vibrio necrotizing fasciitis.
        Clin Orthop Relat Res. 2010; 468: 2230-2237
        • Horseman M.A.
        • Surani S.
        A comprehensive review of Vibrio vulnificus: an important cause of severe sepsis and skin and soft-tissue infection.
        Int J Infect Dis. 2011; 15: e157-e166
        • Dailiana Z.H.
        • Rigopoulos N.
        • Varitimidis S.
        • Hantes M.
        • Bargiotas K.
        • Malizos K.N.
        Purulent flexor tenosynovitis: factors influencing the functional outcome.
        J Hand Surg Eur Vol. 2008; 33: 280-285
        • Pang H.N.
        • Teoh L.C.
        • Yam A.K.
        • Lee J.Y.
        • Puhaindran M.E.
        • Tan A.B.
        Factors affecting the prognosis of pyogenic flexor tenosynovitis.
        J Bone Joint Surg Am. 2007; 89: 1742-1748
        • Bishop G.B.
        • Born T.
        • Kakar S.
        • Jawa A.
        The diagnostic accuracy of inflammatory blood markers for purulent flexor tenosynovitis.
        J Hand Surg Am. 2013; 38: 2208-2211
        • Murray A.
        The management of the infected hand: based on a clinical investigation of 513 cases.
        Med J Aust. 1951; 1: 619-621
        • RJ Neviaser
        • Gunther S.F.
        Tenosynovial infections in the hand: diagnosis and management.
        Instr Course Lect. 1980; 29: 108-128
        • Giladi A.M.
        • Malay S.
        • Chung K.C.
        A systematic review of the management of acute pyogenic flexor tenosynovitis.
        J Hand Surg Eur Vol. 2015; 40: 720-728
        • Gaston R.G.
        • Greenberg J.A.
        Use of continuous Marcaine irrigation in the management of suppurative flexor tenosynovitis.
        Tech Hand Up Extrem Surg. 2009; 13: 182-186
        • Lille S.
        • Hayakawa T.
        • Neumeister M.W.
        • Brown R.E.
        • Zook E.G.
        • Murray K.
        Continuous postoperative catheter irrigation is not necessary for the treatment of suppurative flexor tenosynovitis.
        J Hand Surg Br. 2000; 25: 304-307
        • Michon J.
        [Phlegmon of the tendon sheaths].
        Ann Chir. 1974; 28: 277-280
        • Skeete K.
        • Hess E.P.
        • Clark T.
        • Moran S.
        • Kakar S.
        • Rizzo M.
        Epidemiology of suspected wrist joint infection versus inflammation.
        J Hand Surg Am. 2011; 36: 469-474
        • Margaretten M.E.
        • Kohlwes J.
        • Moore D.
        • Bent S.
        Does this adult patient have septic arthritis?.
        JAMA. 2007; 297: 1478-1488
        • Janis J.E.
        • Hatef D.A.
        • Reece E.M.
        • Wong C.
        Does empiric antibiotic therapy change hand infection outcomes? Cost analysis of a randomized prospective trial in a county hospital.
        Plast Reconstr Surg. 2014; 133: 511e-518e
        • Harrison B.
        • Ben-Amotz O.
        • Sammer D.M.
        Methicillin-resistant Staphylococcus aureus infection in the hand.
        Plast Reconstr Surg. 2015; 135: 826-830
        • Tosti A.
        • Piraccini B.M.
        • Ghetti E.
        • Colombo M.D.
        Topical steroids versus systemic antifungals in the treatment of chronic paronychia: an open, randomized double-blind and double dummy study.
        J Am Acad Dermatol. 2002; 47: 73-76
        • Reilly K.E.
        • Linz J.C.
        • Stern P.J.
        • Giza E.
        • Wyrick J.D.
        Osteomyelitis of the tubular bones of the hand.
        J Hand Surg Am. 1997; 22: 644-649
        • McDonald L.S.
        • Bavaro M.F.
        • Hofmeister E.P.
        • Kroonen L.T.
        Hand infections.
        J Hand Surg Am. 2011; 36: 1403-1412
        • Al-Qattan M.M.
        • Al-Namla A.
        • Al-Thunayan A.
        • Al-Omawi M.
        Tuberculosis of the hand.
        J Hand Surg Am. 2011; 36: 1413-1422
        • Al-Qattan M.M.
        • Helmi A.A.
        Chronic hand infections.
        J Hand Surg Am. 2014; 39: 1636-1645
        • Wolfe C.M.
        • Green W.H.
        • Cognetta Jr., A.B.
        • Baniahmad O.
        • Hatfield H.K.
        Atypical pyoderma gangrenosum of the dorsal hand mimics squamous cell carcinoma.
        J Hand Surg Am. 2012; 37: 1835-1838

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