Three spaces, filled with loose fat, lie between the bases of a patient's fingers in the distal part of his palm. They lie just proximal to his deep transverse ligaments, near his MP joints. Pus more often gathers here than anywhere else in his hand, except in the pulp spaces of his finger tips. It mostly gathers near the palmar surface, but if it is not drained, it may track: (1) posteriorly towards the dorsum, (2) along a lumbrical canal into his middle palmar space, (3) across the front of a finger into a neighbouring web space, or (4) distally into his finger.
Pain and swelling may be so great that he comes for treatment before much pus has formed. The back of his hand is swollen, as in D, Fig. 8-5. If infection is severe, the fingers on either side of the web separate[md]a very useful sign. The point of maximum tenderness is on the palmar surface of the web, and may extend a short way into his palm. Although you may suspect a web space infection, you may find it difficult to exclude an infected tendon sheath.
WEB SPACE INFECTION. For the general method for an infected hand, see Section 8.1.
Make a V-shaped incision between the patient's fingers, as in incision (1), in Figs. 8-5 and 8-6.
If pus is pointing into his palm, pass a probe proximally from the incision you have just made in his web space up into his palm. Its tip should underlie the place where the pus is pointing. Make a second incision there. Scrape the walls of the abscess cavity free from granulation tissue. If necessary, divide some strands of his palmar fascia.