30 - 205 - NAIL SURGERY Flashcards
best technique for inflammatory disorders or lateral longitudinal melanonychia
Lateral longitudinal biopsy
Punch biopsy less than _____ in the distal matrix does not produce serious dystrophy
3 mm
best option for superficial matrix tumors such as wide longitudinal melanonychia or superficial epithelial benign tumors
Tangential shave excision
The nail matrix extends approximately____mm under the proximal nail fold
6 mm
its distal portion is only visible as the white semicircular lunula
The _____ seals and protects the nail cul-de-sac
cuticle
True or False: Isopropyl alcohol scrub and chlorhexidine have proven to be superior to povidone iodine washing.
True
The proximal element of the matrix forms what layer of the nail plate?
superficial third of the nail plate
The distal element of the matrix forms what layer of the nail plate?
inferior two-thirds of the nail plate
anesthesia that can be used and offers the advantage of a rapid onset and a long duration, usually between 8 and 12 hours.
Ropivacaine 2 mg/mL
- This is the more traditionally used block.
- Although less painful than the distal block procedure, the anesthesia takes 5 to 10 minutes to become established.
PROXIMAL DIGITAL BLOCK
A tourniquet effect may inadvertently be produced by injecting more than how many mL of anesthetic and should be avoided
5 mL
- this digital block procedure is more painful than the proximal block procedure, but anesthesia occurs immediately.
- preferred method of anesthesia in the absence of a digital bacterial infection.
- This method is suitable for most procedures performed on the proximal half of the nail unit.
- It is not suitable for matricectomy or complete nail avulsion.
DISTAL DIGITAL BLOCK
- The** flexor tendon sheath** may be used as an avenue for introducing anesthetic to the core of the digit.
- Through centrifugal anesthetic diffusion all 4 digital nerves are anesthetized rapidly.
- Postoperative pain may be more severe than with other techniques.
TRANSTHECAL BLOCK
- This technique involves palmar percutaneous injection of 2 mL of lidocaine or ropivicaine into the potential space of the flexor tendon sheath at the level of the palmar flexion crease using a 3-mL syringe and a 25-gauge hypodermic needle
*
It is preferable not to leave tourniquet on for more than how many minutes?
15 to 20 minutes.
Compressive dressing is mandatory and must not be removed in the first how many hours following the nail surgery?
48 hours
Stitches are removed after how many days of nail surgery?.
7 to 12 days
Pulsating pain beginning after how many hours may indicate an infection?
36 to 48 hours
nonsurgical removal of the nail plate can be done by applying what medication?
40% urea paste
In patients at high risk, nonsurgical removal of the nail plate should be considered when necessary. This can be accomplished by applying 40% urea paste directly to the nail after protecting the surrounding skin. Urea acts on the bond between nail keratin and diseased nail plate, sparing only the normal nail tissue
- This technique minimizes trauma in nail surgery when accessing the nail bed and matrix
- entails separation of all periungual attachments except for that between the dorsum of the nail and the ventral aspect of the proximal nail fold
TRAP DOOR NAIL AVULSION
best technique for the diagnosis of inflammatory disorders as lichen planus or psoriasis when all the subunits of the nail apparatus are involved
LATERAL LONGITUDINAL BIOPSY OR LATERAL FUSIFORM EXCISION
size of punch that may be used for biopsy of a tumor in the proximal nail fold.
2- to 3-mm punch
A 2- to 3-mm punch may be used for biopsy of a tumor. A blister may be completely removed by shave biopsy using half a razor blade
what structure is destroyed when reduction of matrix width is performed?
lateral horn of the matrix
Reduction of the matrix width is a useful and/or necessary procedure in the following major circumstances: need for lateral-longitudinal biopsy, lateral nail splitting, benign or malignant tumor in the lateral third of the nail apparatus, longitudinal melanonychia in a lateral location, ingrown nail, racquet nail.
chemicals used for destruction of the lateral horn of the matrix
88% phenol, 80% trichloroacetic acid, or 10% sodium hydroxide
strongly advocated whenever the surgical specimen of the nail needs histopathologic examination
Scalpel excision
In cases in which pathologic examination of the removed tissue is unnecessary, what is the preferred technique for matricectomy?
phenol cautery, rather than scalpel excision
How is a nail bed partial hematoma (less than 25% of the visible portion of the nail) drained?
it should be drained with a** pointed scalpel or by hot paperclip cautery over the center of the dark spot**
what should be done when there is > 25% hematoma in the nail?
radiograph
A hematoma involving more than 25% of the visible portion of the nail is a sign of significant nail bed injury. A radiograph is mandatory, because the phalanx may be fractured
The nail plate is carefully removed and the hematoma evacuated.
suture size for the nail bed
6-0 resorbable monofilament suture
main cause of recalcitrant chronic paronychia
Presence of a foreign body (eg, hair) under the proximal nail fold
This excision is useful for small distal tumors.
Crescentic excision
The crescent should not exceed 4 mm at its greatest width
Ultrasound shows the pathognomonic sign: the shortening of the distance between the proximal edge of the nail and the distal interphalangial joint.
Retronychia
Retronychia represents proximal regrowth of the nail that occurs when the nail embeds backwards into the proximal nail fold.
most common type of ingrown nail.
Juvenile or subcutaneous embedded nail
The nail is usually embedded medially, but both sides are often affected.
definitive cure for pincer nails
use of phenol cautery on the lateral matrix horns
usually the result of long-standing ingrown nails
Hypertrophic lateral nail folds
