Case report. Pandactylitis of the right hand thumb
Description / Treatment day 1 / Treatment day 3Patient: 23-year-old man
Associated diseases/aggravations:
refusal of admission to the surgical hospital and of antibiotic therapy (multiple antibiotic allergy)
Cause of the wound:
The patient received a minor injury caused by a wood chip when working with glass wool in a torn gauntlet. The narrow and deep wound channel contained a lot of minute foreign bodies, the initial debridement of the wound was not performed. The patient decided to seek medical help after 5 days from the date of injury. Initially he complained of sharp and constant pain, acute edema, impossibility to move the right hand thumb.
The patient had polyvalent allergy in his medical history, which made him refuse antibacterial therapy.
Wounds size: along the entire circumference of the distal phalanx, 2 cm
Depth: 3 cm
Diagnosis:
Pandactylitis of the right hand thumb
Prognosis:
Unfavorable(amputation)
Result: Refusal of amputation, complete healing, disability prevention / / /
Wound assessment:
The both phalanges are acutely edematous. The skin of the distal phalanx is cyanotic and that of the proximal is hyperemic. No active movements in the interphalangeal joint, passive movements cause acute pain. The nail is raised above the nail bed. Axillary lymphadenitis and swelling of the dorsum of the hand are observed.
Wound care:
- Surgical debridement: onychectomy and drainage operation of the distal and proximal phalanges,
- Wound irrigation with 3% hydrogen peroxide and furacillin,
- A dressing VitaVallis is applied. / Wound assessment:
The patient has no complaints. The objective examination shows that the swelling of the dorsum of the hand and axillary lymphadenitis are reduced, the body temperature is normal, overall health is better, but movements in the interphalangeal joint are still very limited. After dressing removal a deep soft tissue defect is observed along the bone to the interphalangeal joint. / Wound assessment:
After dressing removal the wound is free from necrotic tissue with the exposure of a part of the distal phalanx, the swelling of the proximal phalanx is reduced, the granulation tissue started to grow.
Wound care:
- The wound is irrigated with 3% hydrogen peroxide and furacillin
- A dressing VitaVallis is applied
Treatment day 4 / Treatment day 6 / Treatment day 15
Wound assessment:
Considerable contraction of the wound, active granulation, no exudate is produced.
Wound care:
- The wound is irrigated with 3% hydrogen peroxide and furacillin,
- A dressing VitaVallis is applied. / Wound assessment:
No inflammation, reduced swelling of the distal phalanx, active movements in the interphalangeal joint, closure of the soft tissue defect, wound epithelization.
Wound care:
A protective dressing is applied. / The X-rays of the right hand thumb before (left) and after 15 days of treatment (right)
The bone destruction is arrested.