Foreign body reactions Discussion

Foreign body reactions in the upper extremity can result in a variety of problems, including local inflammation, effects of scarring, structural damage, presence of a mass and infection, among others. Signs of progressive problems include pain, size increase or attachment to skin or surrounding structures, ulceration through the skin, or other changes in biologic behavior. Treatment options include observation, aspiration, or surgery. Problems may recur, even after surgical excision. In addition, inflammation thought to arise from foreign bodies may actually be due to infection, including atypical infections. Atypical infections are significant in that they may require surgical excision, treatment for prolonged periods of time with uncommon medications, or both. Such infections pose a variety of problems, including potentially severe life and limb threatening complications. Infections may spread deep within the hand, initially resulting in little outward evidence of a serious problem. Infections may progress rapidly and spread to other areas of the body. Permanent functional impairment is common following the course of a deep hand infection. Because of the potential for long term problems, outpatient management of hand infections requires absolute patient cooperation in taking antibiotics, wound care and clinical status monitoring. Outpatient management requires that the patient seek immediate medical attention if there are warning signs of progression, including fever, chills, or progressive worsening of redness, pain or swelling.

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