The patient usually feels immediate relief as the pressure of pus is relieved.
d. Preparation for Incision and Drainage of Active Paronychia. A minimum
of preparation and supplies is required. The incision and drainage (I & D) procedure can be
performedpainlessly through the necrotic tissue at the cuticle with a needle point scalpel or
an 18gauge needle. Gather this equipment:
Syringe with 25 and 21 gauge needle.
One percent lidocaine (XylocaineR) without epinephrine for digital block.
Scalpel with #11 blade.
e. Procedure. Follow this procedure for the incision and drainage:
(1) Anesthesia. Use the cutaneous nerve block rather than local infiltration.
The digital cutaneous nerves run along the medial and lateral aspects of each finger.
These nerves can be blocked at any level above the distal phalanx.
(a) Use a 25-gauge needle to raise a skin wheal by administering
approximately 0.25 ml of lidocaine directly over the lateral and medial cutaneous nerve.
(b) Change to a 21-gauge needle.
(c) Advance the 21-gauge needle perpendicularly to the nerve (and the
finger) until you reach the bone.
(d) Inject 1 ml of lidocaine.
(e) Slide the needle up and down on the dorsal and volar sides of the
It takes five to ten minutes for complete anesthesia to develop.
Incising the inflamed tissue proximal to the nail. Follow this procedure:
(a) Using a scalpel, make an incision parallel to the axis of the finger.
(b) This incision should be an extension of the lateral and medial nail
groove and deep enough to enter the abscess being treated.