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diffusion of infection of
the hand
Christian Dumontier
Centre de la Main, Guadeloupe
Rare
Anatomical spaces
Deep, clearly
delineated
3 spaces at the hand:
Thenar, mid-palmar &
hypothenar
1 space at the distal
forearm (space of
Parona)
Digito-carpal flexor
tendon sheaths
The radial sheath and
FPL communicate in all
subjects
Ulnar sheath and the
sheath of the little finger
communicate in 80% of
individuals
Radial and ulnar sheath
communicate at the
wrist in 50-80% of
individuals
Many variations
Digito-carpal sheath
Interdigital spaces
Complex anatomy with
crossing of pedicles,
lumbricals and fibrous
structures
Superficial: Natatory
ligament (distal) and
palmar transverse
ligament (proximal)
Commissures
Infection is initally volar
and spreads dorsally
(looser tissues)
Collar-button abscess
Finger Abduction ( dorsal
infection is not accompanied
with finger abduction)
Palmar transverse
ligament (Skoog)
Natatory ligament
Treatment
Dbride both sides of
the web +++
Two incisions
Beware of pedicles
(arteries)
Thenar
Mid-palmar
Hypothenar
Limits
Medial: 3rd metacarpal, oblique
fascia oblique between the 3rd
metacarpal and the palmar
fascia
Dorsal: fascia of adductor
pollicis
Volar: Index sheath and palmar
fascia
Radial : coalition of the palmar
fascia and the aponeurosis of
the adductor policies over the
1st phalanx of the thumb
Flynn, 1942
Limits
Proximal: Carpal
tunnel
Distal: Palmar
transverse ligament
(Skoog)
Some
examples
Treatment
No incision in the axis
of the web (retraction)
Two incisions most
often
Do not forget to drain
up to the middle of the
palm +++
Proximal: Carpal
tunnel
Distal: Palmar
transverse ligament
(Skoog)
Flynn, 1942
Treatment
Surgical drainage
(difficult because of the
rich anatomy)
Many possible incisions
(do it large)
Hypothenar space
Infection
Very rare, after wounds
No possible expansion
Localized pain and
swelling (not dorsal)
Space of Parona
up to 85% of patients:
communication
between the radial and
ulnar sheath and the
midpalmar space