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Collar Button Abscess

- See: Infections of the Hand

- Discussion:
    - type of web space infection, which involves both palmar and dorsal sides;
    - frequently arises from a distal palmar callus, but spreads to the dorsal side;
    - spread of infection is limited by palmarly by the adherence of the palmar skin to the underlying fascia;
           - infection procedes dorsally, just distal to the bifurcation of the common digital vessels, and procedes to involve the dorsal subcutaneous tissues;

- Exam:
    - note amount of swelling on both dorsal and volar surfaces of web;
    - fingers may lie in an abducted position;

- Treatment:
    - requires a volar and dorsal incision;
    - palmar incision:
           - zig-zag incision is made overlying abscess between edge of web and distal palmar crease;
           - protect the digital vessels and nerves;
           - w/ a misquito clamp spread longitudinally into abscess cavity;
    - dorsal incision:
           - make a 2 cm longitudinal incision in the distal web space between the metacarpals;
           - w/ misquito clamp, longitudinally spread into abscess cavity;
    - spread thru subQ tissues so that both palmar and dorsal wounds communicate;
    - irrigate wounds copiously;
    - insert and secure a 14 gauge catheter into palmar wound;
    - palmar wound is loosely closed;
    - insert gauze wick into dorsal wound, and then design bulky hand dressing that can be changed each shift;
    - run D5LR into wound at 50 cc/hour;
    - a second look procedure is performed in 48 hours