Paronychial Surgery

surgery The tissue around nail (paronychial region) prevents infection and inflammation from reaching the proximal nail matrix. A physical or chemical insult most often precedes the introduction of inflammation or infection into the paronychial area. Examples of pathologic conditions include acute and chronic paronychial infections, warts, deep fungi, atypical mycobacteria, myxoid cysts, foreign body and pyogenic granulomas after trauma, and tumors.

The antibiotic treatment is important in preventing permanent nail dystrophy. Staphylococcus aureus is the most common organism cultured in acute paronychial infection. Early antimicrobial therapy and a topical antimicrobial agent is recommended. Wet compresses with Burrow solution, warm soaks, or alcoholic baths and elevation are also used to help control early infection.

If the acute infection fails to respond to antibiotic treatment within 48 hours, surgical management is indicated. The incision and drainage under the digital block is simple procedure to drain the abscess. In recalcitrant case, an excision of the diseased nail fold along with the proximal nail plate is performed.

Surgery of myxoid cysts
Myxoid cysts are usually asymptomatic. However, surgical removal of the cysts is indicated when they become too large and cause pressure on the underlying matrix, resulting in nail deformities. Other indications for surgery include pain, persistent drainage, and development of secondary infection. Conservative treatment may initially be attempted with intralesional corticosteroid injections or by freezing with cryotherapy. When conservative measures prove unsuccessful, elective en bloc excision is performed.

Surgery of warts
The cryosurgery by using liquid nitrogen to freeze the wart remains the most commonly practiced treatment approach, but recurrence is a contentious problem in certain patients. Electrosurgery and laser are reserved for cases of recalcitrant warts.

Before treatment, warts are first debrided. Liquid nitrogen is applied in 3 cycles. During the procedure, the patient may experience pain due to edema produced under the nail bed. If longer freezing times are desired, the patient is made comfortable by administering digital anesthetic. The postoperative complications of freezing include pain, blistering, and transient neuropathy.

Electrosurgery and laser treatment have proven efficacy in the treatment of common warts of the nail.

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