Infections of Deep Hand and Wrist Compartments.

Konstantinos N Malizos,Zoe C Dailiana,Nikolaos Rigopoulos,Socrates E Varitimidis,Efstratios D Athanaselis,Anna N Ziogkou,Zoe K Papadopoulou

doi:10.3390/microorganisms8060838

Konstantinos N Malizos, Zoe C Dailiana + Show 5 more

Open Access

https://doi.org/10.3390/microorganisms8060838

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Abstract

The human hand is the most exposed part of the body to highest risk for injuries, loss of the skin integrity, and to the inoculation of bacteria, most commonly Staphylococcus aureus, Streptococcus β-haemolytic, and gram-negative. In case of an infection, the mobile anatomical structures and the synovial membranes in close proximity to each other may spread the pus towards deep spaces and compartments. Mild early infections without an abscess formation may respond to antibiotics, but at more advanced stage, erythema, swelling, stiffness, and severe pain may ensue. Abscess formation will cause debilitating pain, fever, systemic symptoms, and even sepsis. Necrotizing infections may threaten not only the limb, but also patient’s life. Therefore, an initially “trivial” hand injury should never be neglected, as it might turn into a deep space infection, which must be treated immediately with drainage, wound debridement, and i.v. antibiotics. Delay in diagnosis and inadequate initial management might rapidly lead to abscess formation, destruction of the gliding surfaces and the normal anatomy, and irreparable functional deterioration.

Highlights

Hand and wrist being the most exposed parts, are the most common injured sites of the human body
The destruction of local anatomy further disseminates the infection into adjacent anatomical compartments and the deep spaces of the hand and forearm [4,5]
The accumulation of purulent material increasing the pressure inside an anatomical compartment compromises the blood flow, causing ischemia and tissue necrosis; the infection is subsequently spread towards pathways of decreased resistance

Summary

Introduction

Hand and wrist being the most exposed parts, are the most common injured sites of the human body. The numerous mobile structures are lying superficially under the skin and in close proximity to the bones and joints They are contained within a very limited space and surrounded by synovial membranes that behave as gliding surfaces interconnecting adjacent anatomical compartments. An initially trivial distal finger infection, like felon or paronychia, if left untreated, might expand through the subcutaneous tissue towards the distal phalanx or to the distal inter-phalangeal joint and establish septic arthritis (Figure 1). They might even spread more proximally to the flexors or the extensors, causing septic tenosynovitis [6]. Bacteroides spp., Porphyromonas spp.), and others [13,14]

Clinical Appearance and Diagnosis

Findings

Infections at the Deep Anatomical Compartments