The mainstay of treatment for finger infections is antibiotics and proper wound care. The proper wound care varies for each of the different infections. This can range from a simple incision and drainage of the wound to an extensive surgical exploration of the wound to remove as much infected material as possible.
Some of the infections can be treated as an outpatient, but several will require inpatient treatment and IV antibiotics. Because the organisms that cause these infections are similar, many of the same types of antibiotics may be used.
- Paronychia: Often the wound may be treated with wound care alone. If a collection of pus is present, it will need to be drained. This may be done in several different ways. Commonly a scalpel is used to make a simple incision over the collection of pus to allow drainage. Or the scalpel may be inserted along the edge of the nail to allow drainage. If the infection is large, a part of the nail may be removed. If this procedure is required, the doctor will inject a local anesthetic at the base of the finger that will provide for a pain-free procedure. Most often, you will be placed on an oral antibiotic. You will then be instructed how to take care of the wound at home. (See paronychia.)
- Felon: Often incision and drainage is required because the infection develops within the multiple compartments of the fingertip pad. Usually an incision will be made on one or both sides of the fingertip. The doctor will then insert an instrument into the wound and break up the compartments to aid in the drainage. Sometimes a piece of rubber tubing or gauze will be placed into the wound to aid the initial drainage. The wound may also be flushed out with a sterile solution to remove as much debris as possible. These infections will require antibiotics. The wound will then require specific home care as prescribed by your doctor.
- Herpetic whitlow: Antiviral drugs such as acyclovir (Zovirax) may shorten the duration of illness. Pain medication is often needed. The wound must be properly protected to prevent a secondary bacterial infection and to prevent you from infecting other sites on your body or other people. Incision and drainage is not proper and, if done, may actually delay healing.
- Cellulitis: This infection is superficial, and oral antibiotics are sufficient. If the area is extensive or your immune system is weakened, then you may be treated in the hospital with IV antibiotics.
- Flexor tenosynovitis: This is a surgical emergency and will require rapid treatment, hospital admission, and early treatment with IV antibiotics. Usually the area will need to be surgically opened and all debris and infected material removed. Because of the intricate nature of the fingers and hands, a hand surgeon will usually perform this procedure. After surgery, several days of IV antibiotics will be required followed by a course of oral antibiotics.
- Deep space infections: Much like flexor tenosynovitis, this can require emergency care. If the infection is mild, then only oral antibiotics will be needed. If more severe, a hand surgeon should evaluate the wound and IV antibiotics begun. Often these wounds will require incision and drainage followed by a course of antibiotics.