Surgical Treatment of Deep Space Infections of the Hand



Surgical Treatment of Deep Space Infections of the Hand


Jennifer Etcheson

Jeffrey Yao





ANATOMY



  • The thenar space (FIG 1) is defined by the fascia of the adductor pollicis muscle dorsally and the tendon sheath of the index finger and palmar fascia volarly.



    • The radial border is defined by the insertion of the adductor pollicis tendon and fascia on the thumb proximal phalanx.


    • The ulnar border is the midpalmar (oblique) septum, which extends from the third metacarpal to the palmar fascia.






    FIG 1 • Cross-sectional anatomy of the hand demonstrating the deep spaces.


  • The midpalmar space (see FIG 1) is bordered radially by the midpalmar septum and bordered ulnarly by the hypothenar septum, which extends from the fifth metacarpal to the palmar fascia.



    • The dorsal border of the midpalmar space is the fascia of the second and third palmar interosseous muscles, and the volar border is the flexor sheaths of the long, ring, and small fingers and the palmar fascia.


  • The hypothenar space (see FIG 1) is bordered radially by the hypothenar septum and dorsally by the periosteum of the fifth metacarpal. The fascia of the hypothenar muscles forms the ulnar and palmar borders.


  • The interdigital subfacial web spaces are three interdigital spaces at the distal end of the palm containing loose subcutaneous fat. These spaces are located near the metacarpophalangeal joints, just proximal to the deep transverse ligaments.


  • Parona space is a deep potential space in the distal forearm superficial to pronator quadratus and deep to the flexor digitorum profundus tendons. It is continuous with the midpalmar space.


PATHOGENESIS



  • Thenar space infections may result from penetrating injury or local spread from adjacent flexor tenosynovitis or a subcutaneous abscess.


  • If not treated early, the infection may spread to the dorsal side of the hand after destroying the fascia of the adductor pollicis muscles and traveling between the transverse and oblique heads.


  • Midpalmar space infections usually result from direct penetrating trauma but may also result from spread of an adjacent flexor tenosynovitis or superficial abscess.


  • Hypothenar space infections usually result from direct penetrating trauma but may also result from spread of a superficial abscess.


  • Interdigital subfacial web space infections usually result from penetrating injury but may also result from spread of an adjacent lumbrical canal infection or infected palmar blister.1


  • Parona space infection may result from direct penetrating trauma, in which case the infection may be isolated to Parona space.



    • Infection involving Parona space may also result from contiguous spread from a ruptured radial or ulnar bursae (FIG 2). The end result will be involvement of the midpalmar space and a horseshoe abscess (FIG 3).







FIG 2 • Radial and ulnar bursae may communicate in the distal volar forearm (Parona space).


PATIENT HISTORY AND PHYSICAL FINDINGS

Jul 22, 2016 | Posted by in ORTHOPEDIC | Comments Off on Surgical Treatment of Deep Space Infections of the Hand

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