1 Scar formation Bleeding Procedure The use of procedural sedation may be a useful adjunct to digital block in an anxious child Have an assistant hold the hand supinated on a table top Locate the felon in the pulp space ( Fig 130.37A ) between the volar soft tissues and the periosteum of the distal phalanx The incision should be made at the site of maximal tenderness Anesthetize the finger with a digital nerve block, as described in Procedure Digital and Metacarpal Nerve Block After anesthesia is achieved, cleanse the fingertip with antiseptic solution Don sterile gloves Make a longitudinal incision ( Fig 130.37B ) over the site of maximal tenderness using a no 11 scalpel blade A felon is an abscess and should be drained where it points, just like any other abscess When pus is encountered, enlarge the incision to the proximal and distal limits of the abscess FIGURE 130.37 Incision and drainage of a felon Do not divide the septa Previously described techniques, such as the “fishmouth” and lateral incisions, are associated with iatrogenic complications These include skin slough, permanent anesthesia, unstable fat pad, pain, and an unsightly scar After drainage, place a small gauze wick in the opening ( Fig 130.37C ) to keep the wound edges separated Place a bulky dressing, and immobilize the hand with a short forearm splint In 24 to 48 hours, remove the dressing and inspect the wound Subsequent dressing changes may be done every days Systemic antibiotics are recommended INCISION AND DRAINAGE OF A PARONYCHIA Indications