The treatment by surgery
Normally, nail bed inflammation, also known as paronychia in medical jargon, is treated conservatively, i.e. with finger baths, antibiosis and immobilization of the corresponding finger. If the course of the nail bed inflammation is complicated, surgical measures may also be necessary to relieve the symptoms. In this case, the site of pus is opened at the punctum maximum (point where something is strongest) under local anesthesia, so that the pus (pus) can be emptied.
In mild cases, an incision is made in the fold of the fallopian tube. With the help of forceps, the incision can be spread apart so that the pus can drain off. From this a bacteriological smear can be taken, so that a microbiological laboratory can determine the germ causing the pus.
However, if the pus is underneath the nail, it must be partially removed, as this is the only way to ensure complete drainage of the pus. The partial resection of the affected nail is performed with the help of a so-called emmert plasty, in which a nail wedge resection is performed. Under local anesthesia a wedge-shaped piece of the toe or finger nail including the adjacent nail matrix (nail fold, nail wall) is removed.
If an ingrown nail (Unguis incarnatus) is responsible for the inflammation of the nail bed, the surgeon can also reduce the size of the nail by means of an Emmert plasty. After appropriate hemostasis, the wound is not sutured. It then heals under a sterile bandage without further precautions.
If necessary, flaps can be placed in the wound during the surgical procedure so that pus can continue to drain. The flaps can usually be removed after a few days, provided the pus formation has stopped. After completion of the surgical measures, a disinfectant ointment dressing is applied.
In the following days, a daily change of dressing is indicated in the attending physician’s office, which should also include finger baths with disinfectant solutions. In addition, the affected finger should be immobilised afterwards with the aid of a positioning splint. Antibiotic therapy is also indicated, since nail bed inflammation is mainly caused by bacteria such as staphylococci.
After a few days, the result of the bacteriological smear is usually available, so that the antibiotic therapy can be adjusted if necessary. It is of enormous importance that even a layman does not open up the pus-filled area or manipulate it, because otherwise he can provoke a dangerous germ transfer. If an appropriate therapy for nail bed inflammation is not provided, the infection can spread further and destroy the nail bed or even lead to a so-called panaritium. This is an infection of a finger with melting of tissue.
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