Houston Methodist. Leading Medicine

Hand FAQ

Question:

Have you ever heard of someone developing an opening in the hand that wouldn't close? I cut myself on a sharp piece of glass and ended up having stitches. Once the stitches came out, there was still a hole the size of a pin head that keeps oozing and draining fluid. Should I wait and see if it will eventually go away?

Answer:

You may have developed something called a fistula. A fistula is an abnormal channel or passageway between two places that normally do not connect. In the case of a hand injury like you describe, the tract could be from the lining around a tendon out through an opening you see in the skin. The opening between these two places allows synovial fluid from inside the lining of the tendon to escape through a hole in the palm. This is a rare problem but one that other patients report causes a frothy fluid to drain from an opening called the sinus in the palm. The skin around the sinus may soften and start to break down causing the skin to develop a maceration. Pain, loss of motion, and decreased strength may occur. Treatment for the problem may be conservative (nonoperative) with antibiotics and immobilization in a splint. But if the fistula does not heal and the problem continues, then surgery may be needed. The surgeon may have to remove the entire tract that forms the fistula including the skin around the fistula's opening. A skin graft to cover the opening may be needed for successful wound closure. Just removing the fistula and closing the opening does not work. The quality of the macerated skin around the opening does not allow that area to be used. Complete healing of the fistula requires fresh, undamaged skin. Your problem may be more simple than what we just described. The first and best thing to do is see a hand surgeon. A proper evaluation and diagnosis are the most important parts of getting treatment started. Even though the opening is only pinprick size, it's best to get this looked at sooner than later -- especially before a deep (unseen) infection develops. Nash H. Naam, MD. Flexor Tenosynovial Fistulas in the Palm. In The Journal of Hand Surgery. May 2012. Vol.37A. No. 5. Pp. 925-929.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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