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[Severe infections within the upper extremity--analysis of the causes and methods of treatment].

INTRODUCTION
Infections within the upper extremity can be a cause of serious problems when not treated early and adequately. Apparently looking innocuous at the beginning, infection can spread through synovial sheath of the tendons from finger to the hand, wrist and forearm finally developing phlegmone of the upper limb. The objective of the study was to review the methods of treatment of deep infections of the upper limb and to analyse the causes of severity.


PATIENTS AND METHODS
Thirty-seven patients with deep infections within upper limb were identified in the Department over the period of 1999-2005. Patients included 28 men and 9 women in mean age of 50 years. The delay between initial event and referral to hospital was mean of 12 days (range 2-62). The most common cause was superficial contusion of the hand--13 patients, small wound of the hand--8 and bite--6 patients. In 14 cases infection was localised in the finger (felon), in 23 patients within the hand, wrist, forearm or arm. In 6 of these 23 patients whole distal part of the extremity, from finger to the forearm was involved. All patients were operated on under regional anaesthesia with the use of tourniquet. Several wide incisions were performed, pus and necrotic tissues were removed and wounds were further managed in the open manner. Antibiotic therapy was used in all cases.


RESULTS
A staphylococcus aura was the most common precipitating organism, found in 271 of 30 patients (90%). In 5 patients (13%) infection was so deep that resulted in necrosis and amputation was necessary. Amputation of the single finger was performed in 3 patients, an amputation of 3 fingers was necessary in one patient, and other one lost whole forearm. Healing of the wounds was facilitated by secondary suture, skin grafts and pedicled flaps in 17 cases. Mean time of stay in the hospital was 7 days (range 4-38). The most common causes of development of severe infections were ignorance of GPs who treated too long superficial infections, and stupidity of the patients themselves who delayed visit the doctor until infection became extremely severe.


CONCLUSION
The following algorithm in the treatment of infections of the upper extremity: operation under adequate anesthesia and in bloodless field, wide incisions, drainage, and early mobilization of the limb, in our opinon reduces risk of the amputation and severe functional impairment of the hand.