How is the simple incision technique performed for acute paronychia?

Updated: Oct 09, 2020
  • Author: Elizabeth M Billingsley, MD; Chief Editor: William D James, MD  more...
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Answer

The most simple and, often, least painful incision can be made without anesthesia, using only an 18-gauge needle. The technique is performed as follows:

  • The needle is positioned bevel up and laid horizontally on the nail surface; it is inserted at the lateral nail fold where it meets the nail itself, at the point of maximum fluctuance

  • The skin of the nail fold is lifted, releasing pus from the paronychia cavity

  • A gentle side-to-side motion may then be used to increase the size of the incision made by the needle, improving drainage; since the area incised is made up mostly of necrotic tissue, this is often painless

  • Gentle pressure can be placed on the external skin to express any remaining pus from the paronychia

  • The cavity can then be irrigated with saline

  • A small piece of 1/4-in gauze or iodoform tape can be inserted into the paronychia cavity for continued drainage. The wound is subsequently covered with a sterile bandage.


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