The Hip book
Home » Bones » Hand » Paronychia


- See:
     - Hand Infections
     - Phalangeal Injury - Menu
     - Nail Bed Injuries:

- Discussion:
    - when infections extend under nail & chronic inflammatory process develops, often a pyogenic granuloma develops;
    - in some cases, these patients will have weakened immune system (elderly, diabetes, ect);
    - inciting causes:
           - w/ atypical cases of paronychia, consider metastatic carcinoma (see: nail bed biopsy);
           - penetrating wounds may leave behind foreign bodies & cause granulomas or infections;
           - keeping hands in a wet environment (dish washer);
    - inciting organisms:
           - Pseudomonas
           - Staph aeureus
           - Myobacterium marinum
           - Candida

- Non Operative Treatment:
    - acute paronychia, consider PO antibiotics and warm soaks to promote drainage;
    - avoid immersion of hands in contaminated water, and use a hair dryer to frequently dry hands;
    - cease manipulating cuticles;

- Operative Treatment:
    - after adequate metacarpal block, use a freer elevator to lift the eponychyium, away from the nail, allowing drainage of pus;
    - partial nail removal:
           - see technique of nail removal;
           - w/ more extensive infection, remove the entire nail or a portion of the nail;
           - avoid making incisions parallel to the nail fold, unless absolutely necessary, since nail deformity may result;
           - curretting may result in full thickness loss of matrix in that area which result in very severe nail bed deformity if left untreated;
    - salvage treatment consists of removing a split thickness graft fromm adjacent normal matrix of the same fingernail and using it to resurface 
           the area of missing tissue;

- Onycholysis:
    - significant injuries to nail bed, or sterile matrix, will interfere w/ nail bed being able to adhere and will subsequently cause onycholysis;
    - onycholysis can result in any number of deformities that not only look bad but also cause chronic irritation;
    - sometimes fungal infections can be treated adequately by just removing nail & allowing it to regenerate while treating with topical
           antifungal agents

Eponychial Marsupialization and Nail Removal for Surgical Treatment of Chronic Paronychia.

Paronychia: a mixed infection. Microbiology and management.