Management of Finger Felons and Paronychia: A Narrative Review

Finger felons and paronychias are common presentations to the emergency department with significant morbidity and long-term pain if not managed appropriately.

This narrative review provides a focused summary of the management of finger felons and paronychias for emergency clinicians.

Finger felons consist of the accumulation of pus in the pulp space of the digit, which can lead to digital compartment syndrome if not adequately drained. Paronychias are an infection involving the proximal or lateral nail folds. Early felons and paronychia may be managed with antibiotics alone, whereas more advanced infections require incision and drainage. The preferred approaches for a felon drainage are a longitudinal incision in the volar space if superficial or lateral space if deep, with careful attention not to extend past the distal interphalangeal joint space. Extension to a hockey stick or fish mouth incision may be indicated in select cases. For paronychia, a simple incision approach is preferred for simple paronychia with abscess, while single or double incision technique along the nail is preferred for more complex cases.

It is essential for emergency physicians to be familiar with the management of finger felons and paronychias. We review the different approaches to management, with the goal of providing a resource for those interested in expanding their knowledge of felon and paronychia management.