Hand infections

Abstract

The integument provides only a limited barrier to protect the multiple functional structures of the hand from infection by common bacteria and other rare organisms. If infection is limited to just skin cellulitis, then antibiotics and careful monitoring may be all that is needed. Once bacteria become trapped in a deeper soft-tissue space and form an abscess then debridement must be performed to evacuate the purulence and necrotic tissue. Specialized compartments in the hand such as the pulp space, nail folds, joint cavities, and tendon sheaths facilitate bacterial containment and abscess formation, rendering immune response less effective. Osteomyelitis can originate from direct penetration or spread from an adjacent soft-tissue infection. Orthopaedic devices foster the development of a biofilm that can harbor bacteria, making resolution more difficult. The surgeon should obtain tissue for laboratory analysis at the deep infection site and subsequently administer empiric antibiotics while awaiting culture results. Greater duration of antibiotics is needed for infections of synovial tissues and bone. Unique infections caused by rare organisms may affect the hand, requiring recognition based on specific clinical features and confirmation by specialized laboratory testing.