Paronychia Incision and Drainage

Other Names

• Paronychia Incision and Drainage

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Background

Illustration of the fingernail anatomy

Key Points

• Indicated when paronychia with abscess is present
• Perform digital block for pain control
• Incise parallel to the nailbed using a scalpel

Anatomy of the Nail Bed

• Nail body is composed of densely packed dead keratinocytes
• Paronychium: soft tissue lateral to the nail bed
• Perionychium: paronychium plus the nail bed

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Indications

• Paronychia

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Contraindications

• Absolute
  • Anaphylaxis to injectates
  • Uncertainty on the diagnosis
• Relative
  • Can be treated with less invasive means

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Procedure

A, The area of fluctuance is incised. B, The abscess is decompressed. C, A probe is used to break up any loculations

Mechanical draining of acute paronychia using (A) a 22-gauge needle, bevel up, or (B) a scalpel

Equipment

• Sterile prep (i.e. chloraprep, chlorhexidine, iodine, etc)
• Gloves
• Materials for digital block including syringe, 25 gauge needle, local anesthetic
• Scalpel (#11 or #15)
• Scissors/ forceps
• Nail elevator device (not required)
• Irrigation solution
• Dressing materials

Technique

• Goal: decompress the abscess
  • Start with digital block of the affected digit
  • Small abscess
• Transverse incision through the fluctuance is typically adequate
  • Blade should be parallel to the plane of the nail
• Large abscess
  • Must examine for pus deep to the nailbed (subungual abscess)
  • Can examine by nail elevator to loosen adherence to the eponychia/paronychia
  • If present, the nail should be removed

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Aftercare

• Wound care
• Dressing should include interface dressing (i.e. xeroform gauze, non-stick, etc), gauze, digital dressing

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Complications

• Complications are rare
• Possible pain, bleeding, infection, scarring
• Specific risks: recurrence, incomplete removal of infection, damage to structures or the nail itself

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See Also

• Procedures Main
• Finger Pain Main

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