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

• Paronychia is an infection of the lateral nail fold.
  
• Incision and drainage of paronychia should be performed when inflammation has progressed, leading to a collection of pus inside the nail fold.
  
• If neglected, it may extend around the entire nail margin and cause a floating nail.
  
• The usual pathogen is S. aureus. Cultures are rarely necessary.

Contraindications

• Herpetic whitlow is a viral infection of the fingertip involving intracutaneous vessicles.
  
• This must be differentiated from paronychia because whitlow is NOT incised.

Equipment

• No. II scalpel
  
• Zinc oxide
  
• dressing

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

• Patient should elevate the part, and return in 2-3 days

Felon

Indication

• A felon is an abscess of the distal fat pad of the digit.
  
• Incision and drainage of a felon should be performed when inflammation has progressed, leading to a collection of pus within the tuft pad of the distal pharynx.
  
• If neglected, it may extend around the entire digit and hand leading to tenosynovitis.
  
• The usual pathogen is S. aureus. Cultures are rarely necessary.

Equipment

• Digital block anesthesia
  
• No. II scalpel
  
• Zinc oxide

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

• The wound should be checked in 1-3 days to be
  certain pain is less and drainage is adequate