Keep fingers clean and dry. For maximum patient comfort, the digit is anesthetized with an appropriate digital nerve block. The nail plate and surrounding skin are cleaned with an appropriate antiseptic agent. Blunt dissection with the tip of a sharp instrument or point of a surgical blade is used to elevate the lateral nail fold. The operator attempts to enter the sulcus between the lateral nail plate and lateral epithelium.
Purulent drainage can erupt when the sulcus is entered by the instrument tip.
The lateral fold of skin should be elevated slightly and irrigated with isotonic sodium chloride solution using a catheter tip syringe. In such cases, or when a large paronychia is present, the cavity should be splinted open with a small wick to prevent adhesion and reformation. If purulence has tracked under the nail, excision of the ipsilateral nail may be necessary. The degree of debridement is commensurate with the degree of nail bed infection. It is necessary to consult a hand surgeon if cellulitis, deep space infection, glomus tumor, mucous cyst, or osteomyelitis is suspected.