The LSUHSC New Orleans
Emergency Medicine Interest Group

Presents

The Student Procedure Manual


Infections of the Digits
(I&D of Paronychia and Eponychia)

by Nicole Charbonnet
with Patrick Hymel

Paronychia
-Indications
-Contraindications
-Equipment
-Procedure
-Follow-up
Felon
-Indications
-Equipment
-Procedure
-Follow-up

Paronychia

Indications

Contraindications

Equipment

Procedure

  1. If the paronychia is very painful to touch, a digital block should be performed (see digital block, anesthesia)
  2. Treatment of a small paronychia consists of inserting a #II blade into the nail fold parallel to the nail to drain the abcess. This is all that is usually required.
  3. In an advanced infection, or if puss is seen under the nail, the comer of the paronychium should be incised and the nail fold lifted.
  4. Elevate the nail fold at the site of maximum tenderness or pus. Generally, there is no pain if an abscess is already pointing and no blood is drawn with the scalpel.
  5. A portion of the nail may have to be removed and a wick placed for drainage. Avoid injury to the nail bed.
  6. If a wick is placed, check the wound and replace the wick in 24hrs. After 48 pull the wick and begin warrn soaks.
  7. Use zinc oxide ointment under dressing.

Follow-up

 

Felon

Indication

Equipment

Procedure

  1. see digital block anesthesia
  2. A felon should be drained where it points, usually in the mid pad.
  3. Make a central longitudinal incision with care not to cross the flexion crease of the distal joint. (Note: fishmouth or lateral incisions may do harrn to blood vessels and nerves, and often do not adequately treat the problem.)
  4. Use zinc oxide under the dressing.

Follow-up

 


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