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Subject: Paronychia Surgery
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A recommended anesthesia tray is shown in Appendix F.
A typical surgical tray is shown in Appendix G.
Abscess formation or severe pain in acute paronychia
Lack of response to medical therapy and avoidance of moisture and irritation
Deformity (i.e., loss of the proximal nail fold) in chronic paronychia
Unfamiliarity of the practitioner with the techniques
Bleeding diathesis or coagulopathy
Chronic paronychia surgery in an unreliable patient or person unable to provide wound care
PITFALL: Failure to elevate the tissue sufficiently may permit pus to remain in the site. Because the opening over the nail plate is small and does not involve an incision, the site can reseal, and the abscess can redevelop. Several sites along the nail fold may require elevation to ensure adequate drainage, and the patient should be re-examined in 2 days to check for reformation of the paronychia.
Pearl: The flat elevator may then position beneath the proximal nail fold to protect underlying tissues during the excision.
PITFALL: Meticulous wound care is required after this procedure, and the surgery is appropriate only for patients who are able and willing to provide this care. Some physicians apply a combination antifungal and steroid ointment at night and antibiotic ointment during the day until the wound heals.
Paronychial infections may spread
Secondary ridging, thickening, and discoloration of the nail
Nail loss (rare)
Instruments used for paronychia surgery, such as no. 11 scalpel blades, can be obtained from local surgical supply houses.
Freer septum elevators can be purchased from surgical instrument dealers or through surgical supply houses.
A suggested anesthesia tray that can be used for this procedure is listed in Appendix F.