- See:
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Hand Infections
-
Phalangeal Injury - Menu
-
Nail Bed Injuries:
- Discussion:
- when infections extend under nail & chronic inflammatory process develops, often a
pyogenic granuloma develops;
- in some cases, these patients will have weakened immune system (elderly, diabetes, ect);
- inciting causes:
- w/ atypical cases of paronychia, consider metastatic carcinoma (see:
nail bed biopsy);
- penetrating wounds may leave behind foreign bodies & cause granulomas or infections;
- keeping hands in a wet environment (dish washer);
- inciting organisms:
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Pseudomonas
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Staph aeureus
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Myobacterium marinum
-
Candida
- Non Operative Treatment:
- acute paronychia, consider PO antibiotics and warm soaks to promote drainage;
- avoid immersion of hands in contaminated water, and use a hair dryer to frequently dry hands;
- cease manipulating cuticles;
- Operative Treatment:
- after adequate metacarpal block, use a freer elevator to lift the eponychyium,
away from the nail, allowing drainage of pus;
-
partial nail removal:
- see
technique of nail removal;
- w/ more extensive infection, remove the entire nail or a portion of the nail;
- avoid making incisions parallel to the nail fold, unless absolutely necessary,
since nail deformity may result;
- curretting may result in full thickness loss of matrix in that area which result
in very severe nail bed deformity if left untreated;
- salvage treatment consists of removing a split thickness graft fromm adjacent normal matrix
of the same fingernail and using it to resurface the area of missing tissue;
- Onycholysis:
- significant injuries to nail bed, or sterile matrix, will interfere
w/ nail bed being able to adhere and will subsequently cause onycholysis;
- onycholysis can result in any number of deformities that not only look
bad but also cause chronic irritation;
- sometimes fungal infections can be treated adequately by just removing
nail & allowing it to regenerate while treating with topical
antifungal agents;
Eponychial Marsupialization and Nail Removal for Surgical Treatment of Chronic Paronychia.
Bednar-MS.
Lane-LB.
Abstract/Commentary: 1992 Year Book of Hand Surgery. Article 4-10.
Original Article: J Hand Surg. 1991. 16-A. pp 314-317.
Paronychia: a mixed infection. Microbiology and management.
