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PARONYCHIUM APPROACH

USES

The nail and the paronychium are exposed to treat injuries to the nail bed, to drain infection of the eponychial or paronychial folds (paronychia), or to perform a nail ablation for painful deformities of the nail.

ADVANTAGES

This approach provides excellent exposure of the nail bed.

DISADVANTAGES

Inadvertently cutting into the nail bed may lead to subsequent nail deformity, such as ridging.

STRUCTURES AT RISK

Very little is at risk in this approach, with the exception of the nail bed itself.

TECHNIQUE

The treatment of paronychia uses a longitudinal incision at the corner of the nail, and extending proximally for approximately ½ cm. The nail wall is elevated and the purulence is decompressed. For infections that have migrated across to the opposite side of the nail, a similar longitudinal incision is made in that corner of the nail, and the eponychium and nail wall are elevated. When the infection has extended below the nail, the proximal portion of the nail can be elevated off the underlying nail bed and the proximal one-third to one-half of the nail can be excised.

In treating traumatic injuries to the nail bed, the nail is gently elevated off of the nail bed. The removed nail can be saved to use as a splint following repair of the nail bed.

TRICKS

Related posts:

Volar Approach to the Basal Joint of the Thumb (for Bennett’s Fracture) Anterior Approach to the Distal Thigh and Femur Anterolateral Approach to the Tibia Deltopectoral Approach Posterior Approach Anterior Approach to the Cervical Spine

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