A paronychia, an infection which is an abscess of the skin surrounding the fingernail, is treated by draining the pus with needle puncture followed by scalpel incision. This video will be followed by "Paronychia Part 2," which will follow Max's finger through its healing.
This patient had pain and swelling increasing in his fingertip, just proximal to the cuticle for a few days before coming to the office for attention. We sprayed the proximal finger at the level of the webspace with ethyl chloride before injecting with 0.5% bupicacaine to hit all four of the digital nerves, creating a "digital block." This allowed us to puncture the abscess with an 18 gauge needle to facilitate drainage. The pus was then milked out through the hole. The entire length of the skin overlying the abscess was incised with a scalpel to make it easier to get a complete drainage. A dressing was then placed over the wound to absorb continuing drainage.
A journal article was referenced which described a study finding that antibiotics do not improve outcomes in paronychia drainage. Acute felon and paronychia: Antibiotics not necessary after surgical treatment. Prospective study of 46 patients.
Pierrart J, Delgrande D, Mamane W, Tordjman D, Masmejean EH - Hand Surg Rehabil - February 1, 2016; 35 (1); 40-3
See a playlist of abscess drainages: https://www.youtube.com/playlist?list=PLzaYikuVSLPk2wWoxqkeM-dWaBvyvTk38
New videos are posted on Friday afternoons.
This video is not intended to diagnose or treat any condition. It is for educational purposes only. It is not a substitute for evaluation by your own doctor.
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Music Credit: "Baila Mi Cumbia (Sting)" by Jimmy Fontenez; Media Right Productions (Royalty Free Music on YouTube Audio Library).