Acute Paronychia Management
Step 1: Health history and physical examination
An abscess is indicated by fluid accumulation; cellulitis is indicated by a subcutaneous cobblestone appearance. Ultrasound should be performed if physical examination alone cannot determine if an abscess is present.
Step 2: Drain abscess using the simple incision technique
Anesthesia is not typically required as the incision is in mostly necrotic tissue and is often painless. a. Position bevel up and laid horizontally on the nail surface
b. Insert the needle at the lateral nail fold where it meets the nail and the point of maximum fluctuance
c. Use the needle to lift the nail fold to release pus
d. Use a gentle side-to-side motion to increase the size of the incision made by the needle
e. Place gentle pressure on the external skin to express as much pus as possible from the paronychia
Step 3: Irrigate the cavity with normal saline
Step 4: Insert a small piece of ribbon packing material into the cavity to facilitate continued drainage
Step 5: Cover the wound with a sterile dressing
Step 6: Provide oral antibiotics if cellulitis present
Most paronychia infections do not require antibiotics and are treated successfully with incision and drainage alone.
