- See:
- 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:
- Pseudomonas
- Staph aeureus
- 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.