Web Space Infections



Web Space Infections


Tiffany J. Pan

John R. Fowler



INTRODUCTION



  • 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


EVALUATION

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