Panaritium subungual

Panaritium subungual is more often due to foreign bodies that fall under the nail, suppuration of subungual hematomas. The diagnosis is simple, based on pain syndrome, tenderness in palpation and a typical accumulation of pus under the fingernail. Treatment is operative, can be performed on an outpatient basis under conductor anesthesia by Obereg-Lukashevich. Usually, there is no need to remove the entire nail plate. Indications for such an intervention is a symptom of a "floating nail plate," that is, an accumulation of pus under the entire plane of the nail with its detachment. More often a partial excision of the nail with the removal of a foreign body.

Panaritium hypodermic is the most common form of purulent finger injury. Typical symptoms are pain, redness of the skin, swelling, infiltration, a sharp increase in pain when flexing the finger. More often the inflammatory process is localized on the nail phalanx. When palpating the probe, tenderness along the tendons or periarticular tissues does not exist. Conservative treatment is possible in the initial stage before purulent tissue melting, lymphangitis, or severe restriction of the function of the finger. A significant increase in pain, especially the first sleepless night due to severe pain syndrome, is an indication for the operation. Conservative treatment: rest in a functional position, elevated limb position, daily control of the spread of hyperemia and edema, therefore it is undesirable to use trays and ointments that can change the skin color. At daily changes of bandages use trays with disinfectants (gibitan hlorgeksidin), then impose a bandage with dioxidinom. Antibiotic therapy can be performed while spreading the infection, but before purulent tissue melting. It is better to use penicillin, cephalosporins. Analgesics are indicated only in exceptional cases. With the progression of the pain syndrome, surgical treatment is indicated. With the localization of the panaritium on the nail phalanx, one can use anesthesia by Oberegu-Lukashevich. On the nail phalanx, the collar-like incision is more often used (with the transition to the lateral surface of the finger). Such interventions can be performed on an outpatient basis. A patient with a panaricium of the main or middle phalanx should be hospitalized. The operation is performed under conductive or intravenous anesthesia with bleeding of the limb (application of the tourniquet to the shoulder). In the course of the surgery, necrotic tissue must be excised. More often, cuts along the lateral surface of the phalanx are closer to the palm without crossing the interphalangeal fold.

After removing the tourniquet, the bleeding stops, for which it is usually sufficient to temporarily press the finger. Apply a bandage with dioxin ointment, levosin, levomycol.

During the operation, sowing pus on the flora and susceptibility to antibiotics are mandatory. Usually after 3-5 days, the pain completely subsides, hyperemia and edema disappear, however, the dressings must be performed daily until the wound is completely healed, since a relapse of the disease is possible.