surgery/ Dr.H.Zaini Lecture (1) Kufa/university * Hand is an organ of grasp as well as an organ of sensation expression & to place in optimal position. The position used for immobilization (metacarpophalangeal joint 90 o flexion, interphalang. Slight flex. thumb adduction, wrist dorsiflexion ) position for healing. * Infection of H. encountered most commonly in manual workers & house wives who frequently suffer from small abrasions or breaks in the course of their works. * In 80% infective org. is staph aurous then strept. Pyogen & gram –ve Bacilli.

* Unless infection can be treated, suppuration will follow. The early detection of pus & accurate localization is of clinical importance. * Edema is a common feature (even in simple infection). * H. inf. Is a prime cause of loss of work & if they are not managed properly are often followed by serious disability & however if treated early they never develop to extend that was common in pre antibiotic era. * Debridement removal of dead tissue, (slough T.) less severity than excision. *Excision –removal of dead & doubtful dead T.

“simple & serious infection” 1-- provision of rest. & elevation of the limbs. 2-- early recognition of presence of pus & accurate localization. 3-- Evacuation drainage of pus & in case of closed fascial space do debridement. 4-- Ab therapy 5-- after care (adequate following after Rx).

1) The optional position 0f hand give rise to collateral ligament of metacarpophalageal & interphalangeal joints are stretched on flexion (the best position). This position can be maintained in blaster slab & sling which provide elevation to decrease the edema. 2) early recognition of pus & accurate localization will follow if the hand is rested. 4). If swollen hand is infected, the Ab start (pn + pencilinase inhibitors Antistaph.) floxacillin. Ab will produce response if given within hrs of infection, they should be given I.V. in a high dose.. In the hand early & rapid sealing of infection will occur (localization & isolation from blood stream ) (so give I.V. high dose)..Once infection has settled, active mobilization of stiff fingers and wrist must be started.

1...General A. 2… Brachial plexus A. type of local anesthesia. - give complete muscular relaxation & ample of time& the flexion creases should not be crossed by the incision perpendicularly more liable for contracture & so should parallel to creases. * muscle relaxant and 2% lignocaine also can be used.

classification 1... Superficial inf. a. Acute paronychia infection of nail fold. b. Chronic paronychia. c. Bulb space infection Subcutaneous inf Deep inf. beneath palmar aponeurosis other classification.... In tra epidemal. Sub cut.. Deep

. Most common inf. of hand which is asubcutical marity following careless nail baring.. Suppuration will following if Ab not received early 50 the pus must be drainage (drained). Not in each type follow the principle of Rx Rx fluxacillin, open gentle shipping of epanychium, excision of loose epanychium.

. Usually history by months.. Onset insidious.. In tea worker & hous wife (most common).. It accompanied by ugly fingers & deformities of nail.. Mainly caused by yeast fungal inf.. Tx. Nystatin Gresioflavin for long time.

. Is a closed space, more pain(with time pus)& throbbing in nature.. Late recognition & drainage of pus lead to ischemia of bone due to affection of B. supply osteomyelitis (not all the terminal phalanx )due to thromboarteritis.. Should Treated early (because it is closed space). Floxacillin is effective if pus occur operation without delay is the rule by short incision at the site of maximum tenderness.. It interfere with shep, no pain on elevation of hand, lymphang.

. Can occur in dorsum & palmer surface. (volar surface).. Give rise to redness, edema &pain so should be treated early.. If pus available can send for culture & sensitivity by swab culture. Rx open the abscess.. It may be difficult to distinguish from purulent blister until deep locus.

. Is triangular in shape.. Give rice to edema of dorsal & palmer surfaces.. It arises from skin racks infected blister. Specrally associated with skin thickening that is similar to corn.. Severe throbbing pain, edema, redness, but with constitutional symptoms (fever, malaise, fatigue----).. Incision of drainage along base of web space.

. Infection arise from:- 1) Penetrating wound (from purulent blister) 2) Infection of blood stream of hematoma. 3) Complication of supportive tenosynoritis.. it is abscess beneath the palmar aponeurosis, it is severe but rare infection of the hand(1%).. Treated by transverse incision of the palmar surface that penetrate the deep fascia under general anesthesia or regional block of the median or ulnar nerve at wrist.. Infection so severe lead to frog hand (more edema& the extention of the hand is not available.. The extension induced severe pain due to deep infection this indicate deep palmar abscess (very imp.)

. Infection of lymph vessels.. Very common due to canula that good site for infection of lymph. V.. Main org. strept. Get entrance through abrasion.. Temp, red streaks ( clear superficial lymph v. ) charackrestic, edema of dorsum.. Once the infection occur in:- A. small & ring finger drain into epitrochlear L.N. B.thumb & index supraclavicular L.N. C.middle Axillary L.N.