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Hand Clin 2020 08;36(3):313-321

Division of Hand Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, MGH Orthopaedic Hand Surgery, Yawkey Center for Outpatient Care, 55 Fruit Street, Suite 2C, Boston, MA 02114-2696, USA. Electronic address:

The fingertip is the most common site of infections in the hand, which frequently are encountered by surgeons, dermatologists, and emergency and primary providers. Their mismanagement may have serious consequences. This review discusses the unique anatomy of the volar fingertip pulp and perionychium and reviews pathophysiology and treatment of acute and chronic paronychia, including the decision for surgical versus medical management, choice of antibiotics, incisional techniques, and postincisional care. Read More

Jt Dis Relat Surg 2020 ;31(1):39-42

Department of Orthopedics and Traumatology, Kayseri City Hospital, Kayseri, Turkey.

Objectives: This study aims to report the outcomes of dorsal V-Y advancement flap technique used for the reconstruction of surgical defects following total matricectomy performed for the onychogryphosis of hand nails.

Patients And Methods: A total of 18 consecutive patients (10 males, 8 females; mean age 38.4 years; range, 24 to 41 years) with 20 onychogryphotic hand nails who underwent total matricectomy and dorsal V-Y advancement flap technique were analyzed retrospectively between June 2015 and March 2018. Read More

Skin Appendage Disord 2019 Nov 4;5(6):386-389. Epub 2019 Sep 4.

Dermatology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.

Cutaneous manifestations of tuberculosis (TB) are rare, particularly from an exogenous source. Involvement of the nail apparatus is extremely rare and has only previously been reported as a secondary involvement. We report the case of a 76-year-old female patient referred to our department with onychodystrophy with purulent drainage of the first left finger, which had developed during the preceding year. Read More

Tech Hand Up Extrem Surg 2019 Sep;23(3):133-137

Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore.

Septic arthritis of the small joints of the hand usually occurs secondary to bacterial inoculation through penetrating injury to the joint, or direct spread of infection from paronychia, felon, or pyogenic flexor tenosynovitis. Surgical treatment involves drainage and irrigation and may involve debridement if there is an open wound. We describe a method of continuous irrigation of septic joints of the hand postoperatively in the ward setting using an intravenous cannula placed within the joint and connected to an intravenous giving set with delivery of physiological fluid using a pump driver. Read More

Am Fam Physician 2019 02;99(4):228-236

U.S. Marine Corps School of Infantry-East, Camp Geiger, NC, USA.

Acute hand infections are often caused by puncture wounds and are generally classified into superficial or deep infections. Superficial infections occur in the skin and subcutaneous tissues, whereas deep infections can involve the tendon sheaths, adjacent anatomic compartments, deep fascial planes, bursae, joint spaces, and bones. Superficial hand infections are more common than deep infections and are typically managed with elevation, warm soaks, splinting in the position of function, analgesics, and empiric antibiotics when indicated. Read More

J Hand Surg Am 2019 Jan 14;44(1):46-54. Epub 2018 Jul 14.

Department of Orthopedic Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX. Electronic address:

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. Read More

Hand (N Y) 2017 09 16;12(5):NP99-NP100. Epub 2017 Feb 16.

1 West Virginia University School of Medicine, Morgantown, USA.

Background: Paronychia is defined as infection afflicting the eponychial nail folds of the hand or foot. Such infections are rarely reported in the perinatal age group, and not previously described in a neonate younger than 2 weeks. Trauma resulting in inoculation of the nail fold is the most common predisposing factor to paronychia. Read More

J Am Acad Orthop Surg 2014 Mar;22(3):165-74

Acute and chronic infections and inflammation adjacent to the fingernail, or paronychia, are common. Paronychia typically develops following a breakdown in the barrier between the nail plate and the adjacent nail fold and is often caused by bacterial or fungal pathogens; however, noninfectious etiologies, such as chemical irritants, excessive moisture, systemic conditions, and medications, can cause nail changes. Abscesses associated with acute infections may spontaneously decompress or may require drainage and local wound care along with a short course of appropriate antibiotics. Read More

J Hand Surg Am 2013 Jun 3;38(6):1189-93. Epub 2013 May 3.

Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA; and the Rothman Institute; Philadelphia, PA 15213, USA.

Purpose: To define the current epidemiology of adult acute hand infections in an urban setting, with the aim of helping to improve empiric treatment, as hand infections represent a major source of morbidity and can result in stiffness and, possibly, amputation.

Methods: We performed an electronic medical record search to identify all patients admitted to our urban academic medical center with diagnoses related to open wounds and infections in the hand and fingers over a 6-year period (2005-2010). We recorded demographic data, location of infection, medical comorbidities, and culture data. Read More

Int J Low Extrem Wounds 2012 Sep 2;11(3):174-6. Epub 2012 Aug 2.

Shanghai Jiao Tong University, Shanghai, Peoples' Republic of China.

This study reports the case of a 71-year-old woman with type 2 diabetes whose paronychia rapidly progressed to the right middle finger and then to the whole dorsal aspect necrosis of the right hand. After admission, the diagnosis of diabetic hand ulcer was established and Streptococcus agalactiae found as the pathogen. The authors controlled glucose, used 3% hydrogen peroxide and sulfadiazine silver in routine dressing, as well as surgical debridement, topical negative pressure, and skin grafting. Read More

J R Coll Physicians Edinb 2012 Mar;42(1):24-6

Department of Rheumatology, MES Medical College, Perinthalmanna, Kerala, India.

Digital gangrene is not usually associated with primary Raynaud's phenomenon (RP). Its presence should therefore alert the healthcare provider to look for an alternative explanation. A 19-year-old female patient with primary RP developed digital gangrene following surgical management of acute paronychia. Read More

J Hand Surg Am 2012 May 3;37(5):1068-70; quiz page 1070. Epub 2012 Feb 3.

Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.

Oper Orthop Traumatol 2011 Jul;23(3):204-12

Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48129, Münster, Deutschland.

Objective: The procedure is selected based on the stage of infection with careful removal of the focal infection in the area of the nail fold.

Indications: All infections of the periungual area.

Contraindications: Herpes infections [1, 12]. Read More

Tech Hand Up Extrem Surg 2011 Jun;15(2):75-7

Heatherwood and Wexham Park Hospital NHS Trust, Wexham, Berkshire, UK.

Management of paronychia should primarily be aimed at preventing any activity that results in impairment of the natural barrier function of the nail fold. Surgical treatments aim to cure paronychia by exposing the inflamed germinal matrix to permit unrestricted drainage. We describe a Swiss roll technique for treatment of chronic and severe acute paronychia. Read More

MMW Fortschr Med 2008 Oct;150(40):31-4

Zentrum Handchirurgie, Mikrochirurgie und Plastische Chirurgie, Orthopädische Klinik München-Harlaching, Schön Kliniken.

Clin Occup Environ Med 2006 ;5(2):369-80, viii

Department of Surgery, University of Louisville School of Medicine, 529 South Jackson Street, Louisville, KY 40202, USA.

Prompt diagnosis and treatment of hand and upper extremity infections is imperative because they have the potential to be life threatening and pose a risk of functional impairment. Serious infections may result in prolonged hospitalization and resultant loss of productivity. The mainstay of treatment continues to be antibiotic therapy, heat, elevation, adequate surgical drainage, and débridement. Read More

J Long Term Eff Med Implants 2005 ;15(5):499-510

University of Virginia Health System, Charlottesville, Virginia, USA.

When considering common bacterial diseases of the skin, rather distinct clinical responses to a variety of bacterial infections have been identified. In these cases, it is the specific site of infection and the attendant inflammatory responses that provide the characteristic clinical picture. When the pyoderma extends just below the stratum corneum, it is called impetigo. Read More

Tech Hand Up Extrem Surg 2005 Jun;9(2):120-1

State Specialist Hospital Ado-Ekiti, Formerly Department of Orthopaedics and Traumatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

The severe deformities of the fingers seen in poorly treated or late presenting cases of paronychia stimulated this prospective study. The aim was to make early diagnosis and to find a simple method of draining the pus in the paronychia. This was a prospective hospital based study at the Wesley Guild Hospital (WGH) Ilesa for 9 months. Read More

Am Fam Physician 2003 Dec;68(11):2167-76

Department of Family Practice, Naval Hospital Jacksonville, Jacksonville, Florida 32214, USA.

Hand infections can result in significant morbidity if not appropriately diagnosed and treated. Host factors, location, and circumstances of the infection are important guides to initial treatment strategies. Many hand infections improve with early splinting, elevation, appropriate antibiotics and, if an abscess is present, incision and drainage. Read More

Br J Plast Surg 2004 Jan;57(1):93-4

Am Fam Physician 2001 Mar;63(6):1113-6

University of Michigan Medical School, Ann Arbor, USA.

Paronychia is one of the most common infections of the hand. Clinically, paronychia presents as an acute or a chronic condition. It is a localized, superficial infection or abscess of the paronychial tissues of the hands or, less commonly, the feet. Read More

Hand Clin 1998 Nov;14(4):547-55, viii

Hand Surgery Service, University of Michigan, Ann Arbor, USA.

Paronychias and felons are the most commonly encountered hand infections. Successful management of an uncomplicated infection involves an accurate diagnosis and prompt initiation of treatment, consisting of the judicious use of an appropriate incision, wound drainage, local wound care, antistaphylococcal antibiotics, and early rehabilitation. Complicated infections occur in immunosuppressed patients or those whose infection has been neglected or mistreated. Read More

Dtsch Med Wochenschr 1996 Sep;121(36):1090-2

Klinik und Poliklinik für Unfall- und Handchirurgie, Universität Münste.

History And Clinical Findings: An 18-month-old infant was admitted for a suspected bacterial hand infection that had developed within 2 days. Examination demonstrated multiple vesicles with erythema involving the dorso-ulnar aspect of the thumb. The infant was in a good condition, had no constitutional symptoms and a history of gingivo-stomatitis 6 months ago. Read More

Acta Med Port 1995 Jul-Aug;8(7-8):409-13

Departamento de Cirurgia Pediátrica, Hospital de Dona Estefânia, Lisboa.

Hand and Foot anatomic and physiologic characteristics make the infections, located there, acquire specific aspects. Seventy seven in-patients admitted and/or with follow-up at the out-patient clinic of Dona Estefãnia Hospital with Hand (25) and Foot (52) infections, were reviewed during the period between January 1991 and January 1994. We treated, out-patients with paronychia (7 of the hand and 42 of the foot), one patient with hand pulpitis, and one with dorsum hand cellulitis. Read More

Ther Umsch 1995 Jan;52(1):75-81

Abteilung für Hand- und periphere Nervenchirurgie, Kantonsspital Basel.

The possibilities of hand injuries lead to the higher incidence of hand infections. The clinical signs of inflammation (pain, swelling, heat, loss of function and red colour) are found in near all cases. The start of pain and its localisation help to find quickly the layer of the inflammatory process. Read More

East Afr Med J 1992 Nov;69(11):616-8

Department of Surgery, Faculty of Medicine, University of Khartoum, Sudan.

One hundred and fifty patients with hand infection seen during 6 months period at Khartoum Teaching Hospital were studied. The disease is more common among young males manual and industrial workers (M:F = 2:1). Common types of hand infections were paronychia in (41%) of patients, volar infections in (30. Read More

J Hand Surg Am 1991 Mar;16(2):311-4

Department of Orthopaedic Surgery, SUNY-Stony Brook School of Medicine 11794.

The herpetic whitlow should be treated nonoperatively. However, a difficult therapeutic dilemma occurs when a whitlow is seen with an established bacterial abscess. We report a case of an adult whose first herpetic whitlow was complicated by secondary periungual abscesses that progressed despite intravenous antimicrobial therapy. Read More

J Ky Med Assoc 1990 Jul;88(7):337-41

Christine M. Kleinert Institute for Hand and Micro Surgery, Louisville, KY.

Many hand infections can produce permanent disability if not treated promptly and aggressively. Glass wounds and paint or grease gun injections can result in serious deep infections and often require immediate treatment in the operating room. The following common infections challenge the treating physician regarding their indications for surgical versus nonsurgical treatment. Read More

Hand Clin 1989 Nov;5(4):515-23

University of California, San Francisco.

Infections of the distal finger have a varied presentation, course, and treatment. As in other hand infections, initial treatment should always include elevation of the extremity and the avoidance of snug clothing or constricting jewelry. Immunosuppressive states and systemic diseases such as diabetes must be considered, for they will alter the action of the causative organisms as well as the intensity of treatment that a patient will require. Read More