eMedicine Specialties > Clinical Procedures > Soft Tissue Procedures

Hand, Paronychia Drainage: Multimedia

Author: Noah Elise Gudel, DO, Resident in Internal Medicine, University of Tennessee Medical Center at Knoxville
Coauthor(s): Mohamad Marouf, MD, Consulting Staff, Department of Emergency Medicine, University Hospitals Health System, Richmond Heights Medical Center
Contributor Information and Disclosures

Updated: Nov 10, 2009

Multimedia

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Media file 1: Classic presentation of a paronychia, with erythema and pus surrounding the nail bed. In this case, the paronychia was due to infection after a hangnail was removed.

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Classic presentation of a paronychia, with erythema and pus surrounding the nail bed. In this case, the paronychia was due to infection after a hangnail was removed.

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Media file 2: This more lateral view shows that no pus or fluctuance is involved in the nail bed itself.

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This more lateral view shows that no pus or fluctuance is involved in the nail bed itself.

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Media file 3: In this case, the treating physician opted to use local anesthesia rather than a digital nerve block. In general, this is not preferred because of the limited subcutaneous space in which to inject the anesthetic.

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In this case, the treating physician opted to use local anesthesia rather than a digital nerve block. In general, this is not preferred because of the limited subcutaneous space in which to inject the anesthetic.

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Media file 4: Plain lidocaine is injected in a fan distribution until blanching is observed surrounding the area to be incised.

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Plain lidocaine is injected in a fan distribution until blanching is observed surrounding the area to be incised.

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Media file 5: The local injection should be placed just proximal to the area to be incised.

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The local injection should be placed just proximal to the area to be incised.

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Media file 6: The increased pressure from the injected local anesthetic causes some spontaneous evacuation of pus.

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The increased pressure from the injected local anesthetic causes some spontaneous evacuation of pus.

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Media file 7: Spontaneous pus drainage after injection with local anesthetic.

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Spontaneous pus drainage after injection with local anesthetic.

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Media file 8: In this case, the wound was opened with a small incision using a No. 11 blade scalpel.

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In this case, the wound was opened with a small incision using a No. 11 blade scalpel.

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Media file 9: The wound can be explored with a blunt probe, clamps, or the blunt end of a cotton swab.

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The wound can be explored with a blunt probe, clamps, or the blunt end of a cotton swab.

(Enlarge Image)

Media file 10: Ensure that all loculations are broken up and that as much pus as possible is evacuated.

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Ensure that all loculations are broken up and that as much pus as possible is evacuated.

(Enlarge Image)

Media file 11: Prior to packing or dressing the wound, irrigate the wound with normal saline under pressure using a splash guard, eye protection, or both.

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Prior to packing or dressing the wound, irrigate the wound with normal saline under pressure using a splash guard, eye protection, or both.

(Enlarge Image)

Media file 12: The wound can be covered with antibiotic ointment or petroleum jelly to prevent bandage adhesion.

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The wound can be covered with antibiotic ointment or petroleum jelly to prevent bandage adhesion.

More on Hand, Paronychia Drainage

Overview: Hand, Paronychia Drainage

Treatment & Medication: Hand, Paronychia Drainage

Multimedia: Hand, Paronychia Drainage

References

Office surgery. In: Rakel R, ed. Textbook of Family Practice. 6^th ed. Philadelphia, Pa: WB Saunders Company; 2002:663.
Hand. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. Vol 1. 5^th ed. St. Louis, Mo: Mosby; 2002:529-30.
Tosti A, Piraccini BM, Ghetti E, Colombo MD. Topical steroids versus systemic antifungals in the treatment of chronic paronychia: an open, randomized double-blind and double dummy study. J Am Acad Dermatol. Jul 2002;47(1):73-6. [Medline].
Opal S, Petropoulos P, Mikolich D, Ferri F. Ferri's Clinical Advisor: Instant Diagnosis and Treatment. Philadelphia, Pa: Mosby; 2008:667.
Roberts JR, Hedges JR. Incision and drainage. In: Clinical Procedures in Emergency Medicine. 4^th ed. Philadelphia, Pa: WB Saunders Company; 2004:738-41.
Rockwell PG. Acute and chronic paronychia. Am Fam Physician. Mar 15 2001;63(6):1113-6. [Medline]. [Full Text].
Noble J. Textbook of Primary Care Medicine. 3^rd ed. St. Louis, Mo: Mosby; 2001:1167-68.
Shaw J, Body R. Best evidence topic report. Incision and drainage preferable to oral antibiotics in acute paronychial nail infection?. Emerg Med J. Nov 2005;22(11):813-4. [Medline].
Clark DC. Common acute hand infections. Am Fam Physician. Dec 1 2003;68(11):2167-76. [Medline]. [Full Text].
Rigopoulos D, Larios G, Gregoriou S, Alevizos A. Acute and chronic paronychia. Am Fam Physician. Feb 1 2008;77(3):339-46. [Medline].
Hand infections. In: Canale ST, ed. Campbell's Operative Orthopaedics. Vol 4. 10^th ed. Philadelphia, Pa: Mosby; 2003:3810-13.
Halstead Residents of the Johns Hopkins Hospital. Chen H, Sonnenday C, Lillemoe K. Manual of Common Bedside Surgical Procedures. 2000:361.
Gmyrek R. Local anesthesia and regional nerve block anesthesia. eMedicine from WebMD. Updated August 7, 2009. Available at emedicine.medscape.com/article/1127490-overview. Accessed December 22, 2007.

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Keywords

paronychia drainage, drain paronychia, paronychia, paronychial infection, inflammation of nail fold, infection of the hand, finger infection, toe infection, onychia lateralis, onychia periungualis, digital nerve block, incision and drainage, I & D, felon, ingrown nail, subungual hematoma, subungual abscess, onychocryptosis, closed-space infections, fingertip pulp, hand infections, osteomyelitis, tenosynovitis, septic arthritis, infection, infection, nail bed infection, nailbed infection

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Contributor Information and Disclosures

Author

Noah Elise Gudel, DO, Resident in Internal Medicine, University of Tennessee Medical Center at Knoxville
Disclosure: Nothing to disclose.

Coauthor(s)

Mohamad Marouf, MD, Consulting Staff, Department of Emergency Medicine, University Hospitals Health System, Richmond Heights Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Chief Editor

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

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eMedicine Specialties > Clinical Procedures > Soft Tissue Procedures

Hand, Paronychia Drainage: Multimedia

Multimedia

Classic presentation of a paronychia, with erythema and pus surrounding the nail bed. In this case, the paronychia was due to infection after a hangnail was removed.

This more lateral view shows that no pus or fluctuance is involved in the nail bed itself.

In this case, the treating physician opted to use local anesthesia rather than a digital nerve block. In general, this is not preferred because of the limited subcutaneous space in which to inject the anesthetic.

Plain lidocaine is injected in a fan distribution until blanching is observed surrounding the area to be incised.

The local injection should be placed just proximal to the area to be incised.

The increased pressure from the injected local anesthetic causes some spontaneous evacuation of pus.

Spontaneous pus drainage after injection with local anesthetic.

In this case, the wound was opened with a small incision using a No. 11 blade scalpel.

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 as much pus as possible is evacuated.

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 or petroleum jelly to prevent bandage adhesion.

More on Hand, Paronychia Drainage

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Pharmacy Editor

Chief Editor