Chronic paronychia treatment: Square flap technique

Abstract

Chronic paronychia is an inflammatory process of the periungual folds that lasts longer than 6weeks. It manifests as hypertrophy of the proximal and lateral nailfolds, absence of cuticle, progressive retraction of the proximal nailfold, and onychodystrophy. Surgical treatment is recommended if there has been insufficient response to 6months of appropriate medical therapies. We describe a new surgical technique that removes the fibrotic tissue without complete excision of the proximal and lateral nailfold, minimizing nailfold retraction and recovery time. We present a case series of 34 fingers (9 patients) treated with this new technique. All nailfolds healed well without complications. At the end of the follow-up, all fingers, apart from 2, were relieved of the preoperative symptoms. The length of the ungual plate was maintained in all patients, with no retraction of the nailfolds. Follow-up period of 6months and small sample size are limitations of this study. This surgical technique can provide an alternative treatment for chronic paronychia, with good prognosis during follow up-period and optimal cosmetic results.