Table 11.

Summary of Surgical techniques for chronic paronychia

Surgical technique	Method	Principle	Advantage	Disadvantage
1. Eponychial marsupialization[37,74]	Removal of a crescent-shaped portion of the dorsal aspect of the PNF. Incision stretches from one LNF to the other and starts 1mm away from the distal margin of the eponychium extending around 6 mm proximally.	Exteriorizes the inflamed, obstructed nail matrix, allowing its drainage. Distal rim of eponychium is spared	Prevents subsequent roughness of the nail plate Easy to perform	Prolonged healing time Retraction of the PNF Postoperative increase of the nail plate’s length.
2. En bloc excision of the proximal nail fold[75]	Removal of a wedge-shaped crescent formed of the entire depth of the PNF, with a width of 5-6mm, extending from one LNF to the other Distal rim of the eponychium is not spared	Exposes nail matrix, allowing drainage Preserving the fibrosed nail fold has no added advantage	More likely to be curative Cosmetically more acceptable Better functional outcome Easy to perform	Prolonged healing time Retraction of the PNF Postoperative increase of the nail plate’s length.
3. Swiss roll technique[4,73]	Incision is made on either side of the nail fold using a no.15 scalpel blade. Nail fold is elevated and reflected proximally, rolled up like a Swiss-roll over a piece of gauze or nonadherent dressing and secured to the skin using two nonabsorbable stay sutures.	Nail bed is exposed to allow adequate drainage of any infectious material.	Preservation of the nail plate Absence of a skin defect which Quick healing Good cosmetic and functional outcome.	Although this technique improves the acute process, it does not solve the chronic fibrosis problem.
4. Square-flap technique[68]	Oblique incisions (4–5 mm) are made on both sides of the proximal nail fold. Next an incision is made parallel to the epidermis and beneath the fibrosis. The fibrotic tissue lying underneath is removed while saving the epidermis of the PNF. The square flap is kept in place and surgical closure is done using simple interrupted sutures.	Aids in removal of the fibrotic tissue without complete excision of PNF and LNF	Healing in 2 weeks and cuticular regrowth in 6 weeks Good cosmetic and functional outcome. Quick recovery Lack of PNF retraction No increase in nail plate length	Nail fold skin quality is of vital importance for the success Technique is neither fast nor easy to perform, Requires a skilled nail surgeon.

LNF = lateral nail fold, PNF = proximal nail fold