What is the role of eponychial marsupialization in the treatment of chronic paronychia?

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

The most common surgical technique used to treat chronic paronychia is called eponychial marsupialization.

In this technique, the affected digit is first anesthetized with 1% lidocaine (Xylocaine), with no epinephrine, using the digital ring block method.

Tourniquet control of the proximal digit may be accomplished by using a finger of a latex glove with the distal end cut off or by using a sterile Penrose drain at the base of the digit firmly secured using a hemostat. The surgery proceeds as follows:

  • With a No. 15 blade, a crescent-shaped incision is made proximal to the distal edge of the eponychial fold; the distal incision is made approximately 1 mm proximal to the distal edge of the eponychium and extends along its curve. A curvilinear proximal incision is then made, extending from the lateral ends of the distal incision and forming a crescent with its widest margin approximately 5 mm from the distal incision; the incision should appear symmetrical

  • All affected tissue within the boundaries of the crescent and extending down to, but not including, the germinal matrix is excised

  • In effect, this procedure exteriorizes the infected and obstructed nail matrix and allows its drainage

  • If the nail plate is grossly deformed at the time of surgery, it may be removed

  • The excised region is packed with plain gauze wick, which is changed every 2-3 days

Epithelialization of the excised defect occurs over the next 2-3 weeks. Nail improvement occurs over the next 6-9 months but may require as long as 12 months to become apparent.


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