This past weekend I treated my own paronychia. Haven't figured out how I developed it, as I had no hang nails, don't chew on my fingernails, no recognized trauma to the digit. I initially treated the red, tender area around the nail with antibiotic ointment and a Band-Aid (to keep the ointment in place and to protect the area from any further injury). At first there was no "fluctuant area" and no localized pus pocket. That was until Sunday morning. Check out the photo I took with my new iPhone (my husband's birthday gift to me). Being a seamstress, there are plenty of needle around my house. I sterilized one and gently lifted the top off the localized pus. I would not recommend that just anyone do this. Remember I am a trained professional.
- The finger can be numbed with local anesthesia (digital block).
- Make short skin incision with a number 11 blade over the area of maximum tenderness. Incise only the skin with scalpel. Do not cross the DIP joint crease (can create a contraction)
- Evacuate any pus (and culture) using a blunt instrument, like a small hemostat. This will decrease the chance of injury to the digital nerve or the tendon sheath (can lead to acute tenosynovitis). Do not divide vertical fascial strands (septa) as this makes the fingertip pulp unstable.
- Pack gauze loosely into the wound to prevent skin closure. Apply a loose dressing, splint finger, and elevate hand above the heart.
- Followup in 2-3 days.
Osteomyelitis involving the distal phalanx.
Infections of the Hand: A Guide to the Surgical Treatment of Acute and Chronic Suppurative ... By Allen Buckner Kanavel (Google eBook)
Wheeless' Textbook of Orthopedics Online
Common Acute Hand Infections--AAFP
Felon by Glen Vaughn, MD--eMedicine article