The surgeon creates specific incisions to access and drain infected areas. These incisions follow anatomical lines to preserve vital structures and provide adequate exposure. The procedure includes copious irrigation with sterile solution to remove debris and infectious material.
Surgery for Hand Infections

Dr Jacqueline Tan
MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)
Surgery for hand infections involves surgical intervention to drain infected material, remove damaged tissue, and deliver targeted antibiotics to treat severe hand infections. This procedure addresses infections that have not responded to conservative treatment or present with complications such as abscess formation, deep tissue involvement, or spreading infection. The surgery aims to prevent permanent hand damage, restore function, and eliminate infection through precise surgical techniques.



Indications for Surgery
The following conditions often require surgical intervention for hand infections.
- Deep Space Infections: Infection spreads into the deeper compartments of the hand, creating pockets of pus that require drainage.
- Failed Conservative Treatment: Infections show no improvement after 24-48 hours of appropriate antibiotic therapy.
- Abscess Formation: Collections of pus develop within the hand tissues, requiring drainage.
- Septic Arthritis: Joint infections cause severe pain and swelling, threatening joint integrity.
- Flexor Tenosynovitis: Infection of the tendon sheath produces severe pain and limited finger movement.
Benefits of Surgery
Surgery for hand infections offers several advantages over conservative treatment alone. These include:
- Rapid Infection Control: Direct access to infected areas allows immediate removal of infectious material and targeted treatment delivery.
- Tissue Preservation: Early intervention prevents further tissue damage and reduces the risk of permanent impairment.
- Function Recovery: Prompt treatment helps maintain hand mobility and strength by preventing complications.
- Diagnostic Clarity: Direct visualisation during surgery confirms infection type and extent, enabling precise treatment.
Surgical Techniques
Different surgical approaches address various types and locations of hand infections.
Incision and Drainage
Debridement
This technique removes dead or infected tissue to promote healing. The surgeon carefully identifies and excises non-viable tissue while preserving healthy structures. Multiple debridement procedures may be necessary for extensive infections.
Flexor Sheath Irrigation
Treatment for tenosynovitis involves opening the tendon sheath to remove infected material. The surgeon creates small incisions at specific points along the finger to access the entire tendon sheath. Continuous irrigation helps remove all infectious material.
Preparing for Surgery
Medical Evaluation
Blood tests assess infection severity and overall health status. The evaluation includes blood count, inflammatory markers, and cultures to identify causative organisms. Additional tests may be required based on medical history.
Medication Adjustments
Blood thinners require temporary discontinuation before surgery. Patients receive specific instructions about timing medication adjustments. Current antibiotic treatments may need modification based on culture results.
Pre-operative Guidelines
Patients fast for 6-8 hours before surgery. The surgical team marks the operative site and reviews medical history. Patients receive detailed instructions about post-operative care and recovery expectations.
Step-by-Step Procedure
Anaesthesia Administration
Based on infection location and extent, the surgeon selects appropriate anaesthesia. Regional nerve blocks or general anaesthesia ensure patient comfort. Vital signs monitoring continues throughout the procedure.
Surgical Site Preparation
The surgeon thoroughly cleanses and drapes the hand, ensuring a sterile environment. The arm is positioned on a specialised table under optimal lighting, and a tourniquet is applied to maintain a bloodless field for better visualisation.
Infection Exploration
The surgeon makes precise incisions, carefully following anatomical landmarks. Dissection is performed to identify the extent of the infection, and tissue samples are collected for laboratory analysis to guide further treatment.
Drainage and Debridement
Infected material is removed, and all infected areas are thoroughly irrigated to minimise bacterial load. The surgeon evaluates tissue viability, excising any non-viable or compromised structures as necessary to promote healing.
Wound Management
Drains are placed if needed to prevent fluid accumulation. Sterile dressings are applied to protect the wound and maintain a clean environment. A splint may be used to immobilise the hand and support healing in the treated areas.
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Post-Surgical Care and Recovery
Immediate Care
Elevating the hand helps minimise swelling and discomfort. Dressing changes are performed regularly to keep the wound clean, while prescribed pain medications and antibiotics are continued to manage symptoms and prevent further infection.
Recovery Process
Physical therapy is initiated when appropriate, with exercises aimed at preserving joint mobility and preventing stiffness. Recovery timelines differ depending on the severity of the infection and the individual’s response to treatment.
Follow-up Care
Scheduled follow-up visits allow the surgeon to monitor healing and assess hand function. Based on recovery progress, additional procedures or treatments may be required to achieve optimal outcomes.
Potential Risks and Complications
Surgery for hand infections carries risks including bleeding, nerve injury, and infection recurrence. Some patients may develop stiffness or reduced range of motion during recovery. Scarring can occur at incision sites, and complete resolution of symptoms may take several weeks to months. Rare complications include chronic pain, complex regional pain syndrome, or need for additional surgeries. The development of antibiotic resistance or persistent infection may require prolonged treatment.
Frequently Asked Questions
What are the risks of leaving a hand infection untreated?
If left untreated, hand infections can result in abscess formation, tissue death, loss of hand function, or severe systemic infections like sepsis.
Are there alternatives to surgery for severe hand infections?
While severe hand infections often require surgery, additional treatments such as high-dose antibiotics or hyperbaric oxygen therapy may be used to support recovery alongside surgical intervention.
How can I prevent future hand infections?
To minimise the risk of future hand infections, practice proper wound care by keeping injuries clean and covered, avoiding contact with contaminated environments, and seeking prompt medical treatment for minor injuries or signs of infection.

Dr Jacqueline Tan
MBBS (SG)
MRCS (Edin)
MMed (Surgery)
FAMS (Hand Surgery)
Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.
- Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
- Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
- Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
- Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.
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