FIG. 277-5. Felon. A. The unilateral longitudinal approach is the most frequently used method for draining felons. This approach minimizes interference with sensate areas of the finger pad. B. If the felon is pointing on the volar surface of the finger pad, the longitudinal volar approach may be used.

A no. 11 blade is introduced lateral to the paronychium and is directed in a volar direction until pus is encountered. The incision should be extended to ensure adequate drainage, although it should not extend to the distal interphalangeal (DIP) flexor crease. Likewise, the incision should not carry through the distal end of the finger pad because this would likely cause instability and loss of sensation to the distal fingertip. A small clamp may be used to bluntly dissect septa to ensure complete drainage. If the wound is large enough, a small wick may be placed to encourage continued drainage.910

If the felon is pointing toward the volar fat pad, a longitudinal volar approach may be used, as depicted in Fig 277.:5jb. Care should be exercised to avoid extending the incision to the flexor crease of the DIP joint. More extensive incisions such as the fishmouth, hockey stick, and through-and-through incisions are rarely, if ever, indicated. These incisions are routinely associated with loss of sensation to the fingertip and instability of the finger pad. 910

Following drainage, the wound should be irrigated and then dressed with a dry, sterile dressing. The patient should be instructed to keep the extremity elevated, and the wound should be reevaluated in 24 to 48 h. Warm soaks may be initiated to keep the wound clean and promote continued drainage.

Most felons have significant associated cellulitis that should be treated with oral antibiotics. 12 A first-generation cephalosporin or antistaphylococcal penicillin should be prescribed for 7 to 10 days or until the infection has abated. Felons not responding to treatments outlined earlier should be referred to a hand specialist for more definitive management and long-term follow-up.

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