How is the single- and double-incision technique performed for acute paronychia?

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

If the paronychia is more advanced, it may need to be incised and drained. A digital anesthetic block is usually necessary. If an anesthetic agent is used, it should consist of 1% lidocaine (Xylocaine). [4, 42] The local injection of the anesthetic agent into the paronychia or the wound is often inadequate and more painful than the administration of drugs of a digital block.

If the paronychia involves only 1 lateral fold of the finger, a single longitudinal incision should be placed with either a number-11 or number-15 blade directed away from the nail fold to prevent proximal injury and a subsequent nail growth abnormality. If both lateral folds of the finger are involved, incisions may be made on both sides of the nail, extending proximally to the base of the nail.

The next steps are as follows (see the images below):

  • After the single or double incision is made, the entire eponychial fold is elevated to expose the base of the nail and drain the pus

  • The proximal third of the nail is removed by using the method described for the no-incision technique

  • After the abscess is drained, the pocket should be well irrigated with isotonic sodium chloride solution, packed with plain packing, and dressed

  • The patient should receive oral antibiotics for 5-7 days

  • The dressing and packing are removed in approximately 2 days, and the affected finger is treated with warm soaks for 10-15 minutes 3-4 times per day

    Wound opened with a small incision using a number- Wound opened with a small incision using a number-11 blade scalpel.
    The wound can be explored with a blunt probe, clam The wound can be explored with a blunt probe, clamps, or the blunt end of a cotton swab.
    Ensure that all loculations are broken up and that Ensure that all loculations are broken up and that as much pus as possible is evacuated.
    Prior to packing or dressing the wound, irrigate t Prior to packing or dressing the wound, irrigate the wound with normal saline under pressure, using a splash guard, eye protection, or both.
    The wound can be covered with antibiotic ointment The wound can be covered with antibiotic ointment or petroleum jelly to prevent bandage adhesion.

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!