When pus collects in the superficial palmar spaces of a patient's hand, it does so under his palmar fascia. Sometimes, it tracks superficially and forms a collar-stud abscess under the superficial layers of his epidermis, as in B, Fig. 8-1.
SUPERFICIAL PALMAR SPACE. For the general method for a hand infection, see Section 8.1.
If you can see pus under the patient's epidermis, remove it and look for a track leading deeper into his hand.
If you cannot see any pus, make a small transverse incision over the point of maximum tenderness, in the line of the nearest skin crease (not illustrated). Probe the abscess cavity. If you find an opening leading to a deeper collection of pus, enlarge it. Scrape infected granulations from the wall of the cavity.
Fig. 8-4 THE THENAR (radial) AND THE MIDDLE PALMAR SPACES lie deep to a patient's flexor tendons, between them and the fascia covering his metacarpals and interossei (see also Fig. 8-1). They communicate with his lumbrical canals. Incise his middle palmar space in the middle third of his distal (or proximal) palmar crease (incision 2), or along the ulnar border of his hand (incision 3). Incise his thenar space in the web between his thumb and his index finger (incision 4), or along his thenar crease in his palm (incision 5). Beware of the motor branch of his median nerve!