Suppurative finger abscess

　　Suppurative paronychia is mostly caused by foreign body injury at the tip of the finger, and can also be secondary to paronychia. The main pathogenic bacteria are Staphylococcus aureus. There are many longitudinal fibrous strands between the skin on the palmar surface of the distal phalanx and the periosteum of the finger bone, which divide the soft tissue into many closed small compartments, containing fatty tissue and a rich network of nerve endings. When infection occurs, pus is not easy to spread to the periphery, so the swelling is not significant. However, the pressure inside the abscess cavity is very high, which can not only cause very severe pain but also compress the nutrient vessels of the distal phalanx, causing ischemia and necrosis of the phalanx. In addition, direct invasion of the pus into the phalanx can also cause osteomyelitis.

　　During the abscess stage, due to the action of fibrous septa, infection can directly spread to the deep layer, which is very easy to form osteomyelitis of the distal phalanx, suppurative arthritis, or tenosynovitis, etc. At this time, after the skin breaks and pus oozes out, the focus is still difficult to improve. For severe infection cases, bacteria can enter the blood circulation system through the focus of infection, causing septicemia and complications such as high fever, shortness of breath, palpitations, and suppurative complications in other tissues and organs. Bacterial infection and its metabolic products can directly damage the myocardium, leading to myocarditis and changes in the T wave, ST segment, and P-R interval of the electrocardiogram.

　　In the early stage of suppurative paronychia, the finger tip may swell slightly, become red, and feel stinging pain. Subsequently, the swelling of the finger tip may worsen, and the skin tension may become significantly larger; the patient often feels severe jumping pain, has difficulty sleeping, and has symptoms such as chills, fever, and general discomfort; in the abscess stage, thrombosis may occur in the microvessels, local tissue tends to necrosis, the entire finger pad can swell greatly, resembling a snake's head; after the abscess forms, the pain in the finger tip may reduce, the skin color may change from red to white, but it is difficult to detect fluctuation, the skin may break and exude pus, and gradually heal.

　　The following points should be noted for the prevention and care of this disease:
　　1. In units prone to suppurative skin diseases (such as some factories, agricultural machinery stations, primary schools, etc.), extensive publicity and education work on the prevention and treatment of suppurative skin diseases should be carried out, regular preventive inspections should be conducted, and all possible factors of disease should be eliminated as much as possible.
　　2. Pay attention to skin hygiene, strengthen physical exercise, and enhance the resistance of the skin.
　　3. Maintain the integrity of the skin function. For skin diseases, especially pruritic skin diseases, reasonable treatment should be carried out in a timely manner. Prevent skin injury, avoid scratching and skin friction, and other stimuli.
　　4. Pay attention to labor protection, for patients with skin trauma or those already infected with the disease, active treatment should be carried out to avoid the aggravation of infection and serious complications.

　　Patients with a history of ingrown toenails or finger trauma, clinical manifestations include red, swollen finger pulp with severe jumping pain and fever. Laboratory examination of blood count shows: the total white blood cell count is often >4×10g/L, and the neutrophils are greater than 0.6.

　　Patients with purulent paronychia generally have no special dietary requirements. However, different dietary standards can be formulated for specific conditions according to the severity, after consulting relevant doctors.

　　Timely treatment of purulent paronychia and proper handling measures do not affect the function of the fingers. The treatment methods for this disease are:

　　1. Local Treatment
　　(1) Place the forearm flat and immobilize it to reduce swelling and pain.
　　(2) Early application of hot compress, potassium permanganate soak, 3% iodine tincture, and active anti-inflammatory treatment can lead to the regression of inflammation. Before the abscess forms, a patch of Yishi Jinhuang powder can be applied to the affected finger.
　　(3) Early incision and drainage: Since it is difficult to find fluctuation in the infected area, incision and drainage should be performed as soon as the jump pain appears or affects sleep, and cannot be delayed. Even if there is not much pus after the incision, it is beneficial to alleviate symptoms and control the deep spread of inflammation.
　　Under digital nerve block anesthesia, a longitudinal incision is made on the lateral side of the distal phalanx, the distal end does not exceed 1/2 of the nail groove, and the proximal end does not exceed the transverse crease of the phalanx. To ensure smooth drainage and easy dressing change, a fusiform skin strip can be excised at the incision site. Necrotic tissue is cleared during the operation, the infected fibrous septum is completely opened, but the integrity of the deep periosteum and sheath should be protected to prevent the spread of inflammation. A latex film drain is placed. It should be avoided to perform bilateral mouth-to-mouth drainage during the operation, and the fish mouth-like incision at the tip of the finger should not be made. The former often leaves a large scar under the finger pulp, making it sensitive to pain when holding or pinching objects, affecting function. The latter is due to the retraction of the scar, making the tip of the finger uneven, affecting function and appearance.

　　2. Antibiotic Treatment
　　First choice of penicillin injection, cephalosporin class for allergic individuals.