Web Space Infections

Web Space Infections

Tiffany J. Pan

John R. Fowler


  • Definition

    • A deep infection of the hand that occurs in the webspace between two fingers

    • It is also known as a collar-button abscess in reference to the dumbbell shape reminiscent of collar buttons from the early 20th century

  • Pathoanatomy

    • Deep subfascial spaces

      • Dorsal subcutaneous space

      • Dorsal subaponeurotic space

        • Dorsal limit—dense aponeurosis of extensor tendons

        • Volar limit—metacarpal periosteum and dorsal fascia of interossei muscles

        • Medial and lateral borders—confluence of aponeurotic sheet and deep fascia over dorsal interossei as well as metacarpal bones and metacarpophalangeal joint capsules

      • Interdigital webspace

        • Loose connective tissue between the metacarpal heads

        • Skin is intimately attached to the palmar fascia volarly but is relatively mobile dorsally

    • Dorsal spread is most common due to the dense attachment of the volar skin to the palmar fascia limiting formation of the abscess

    • Infections are able to track through the loosely organized tissue of the interdigital webspace

  • Mechanism of injury

    • Superficial skin fissure in the webspace

    • Palmar callus

    • Penetrating injury, frequently of the volar surface

    • Attempted injection of IV drugs

    • Extension of infection from adjacent fingers

  • Epidemiology

    • 5% to 15% of hand infections are deep space infections

    • Staphylococcus aureus and group A beta-hemolytic Streptococcus are the most common organisms identified

    • Human bites likely to cause polymicrobial infection


May 7, 2019 | Posted by in ORTHOPEDIC | Comments Off on Web Space Infections
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