Paronychia

Paronychia is an infection beside or proximal to a patient's nail. Pus may track round it, as in A and B, Fig. 8-2; either superficial to his nail as in E, and F, or deep to it as in G, and H. Early antibiotic treatment may abort the infection, but you usually have to drain pus.

PARONYCHIA For the general method for a hand infection, see Section 8.1.

If the pus is superficial to a patient's nail on one side only, incise it by angling the knife away from his nail to avoid cutting his nail bed, as in E, and F, Fig. 8-2.

If the pus lies under one corner of his nail, reflect a little flap and remove that corner only, as in G, and H.

If pus has tracked to the other side of his finger under his nail, make a second incision there, retract the flap, excise the proximal one third of his nail, pack the wound open and drain it, as in I, to L, in Fig. 8-2.

If the infection fails to resolve, or his nail becomes indurated and red, suspect a fungus infection, and examine scrapings microscopically. If you find fungi, remove his nail and apply wet dressings, or a topical antifungal agent, such as Castellani's paint or gentian violet.