30 - 205 - NAIL SURGERY

Question 1

best technique for inflammatory disorders or lateral longitudinal melanonychia

Answer 1

Lateral longitudinal biopsy

Question 2

Punch biopsy less than _____ in the distal matrix does not produce serious dystrophy

Answer 2

3 mm

Question 3

best option for superficial matrix tumors such as wide longitudinal melanonychia or superficial epithelial benign tumors

Answer 3

Tangential shave excision

Question 4

The nail matrix extends approximately____mm under the proximal nail fold

Answer 4

6 mm

its distal portion is only visible as the white semicircular lunula

Question 5

The _____ seals and protects the nail cul-de-sac

Answer 5

cuticle

Question 6

True or False: Isopropyl alcohol scrub and chlorhexidine have proven to be superior to povidone iodine washing.

Answer 6

True

Question 7

The proximal element of the matrix forms what layer of the nail plate?

Answer 7

superficial third of the nail plate

Question 8

The distal element of the matrix forms what layer of the nail plate?

Answer 8

inferior two-thirds of the nail plate

Question 9

anesthesia that can be used and offers the advantage of a rapid onset and a long duration, usually between 8 and 12 hours.

Answer 9

Ropivacaine 2 mg/mL

Question 10

• 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.

Answer 10

PROXIMAL DIGITAL BLOCK

Question 11

A tourniquet effect may inadvertently be produced by injecting more than how many mL of anesthetic and should be avoided

Answer 11

5 mL

Question 11

• 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.

Answer 11

DISTAL DIGITAL BLOCK

Question 12

• 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.

Answer 12

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
  *

Question 13

It is preferable not to leave tourniquet on for more than how many minutes?

Answer 13

15 to 20 minutes.

Question 14

Compressive dressing is mandatory and must not be removed in the first how many hours following the nail surgery?

Answer 14

48 hours

Question 15

Stitches are removed after how many days of nail surgery?.

Answer 15

7 to 12 days

Question 16

Pulsating pain beginning after how many hours may indicate an infection?

Answer 16

36 to 48 hours

Question 17

nonsurgical removal of the nail plate can be done by applying what medication?

Answer 17

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

Question 19

• 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

Answer 19

TRAP DOOR NAIL AVULSION

Question 20

best technique for the diagnosis of inflammatory disorders as lichen planus or psoriasis when all the subunits of the nail apparatus are involved

Answer 20

LATERAL LONGITUDINAL BIOPSY OR LATERAL FUSIFORM EXCISION

Question 21

size of punch that may be used for biopsy of a tumor in the proximal nail fold.

Answer 21

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

Question 22

what structure is destroyed when reduction of matrix width is performed?

Answer 22

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.

Question 23

chemicals used for destruction of the lateral horn of the matrix

Answer 23

88% phenol, 80% trichloroacetic acid, or 10% sodium hydroxide

Question 24

strongly advocated whenever the surgical specimen of the nail needs histopathologic examination

Answer 24

Scalpel excision

Question 25

In cases in which pathologic examination of the removed tissue is unnecessary, what is the preferred technique for matricectomy?

Answer 25

**phenol cautery**, rather than scalpel excision

Question 26

How is a nail bed partial hematoma (less than 25% of the visible portion of the nail) drained?

Answer 26

it should be drained with a** pointed scalpel or by hot paperclip cautery over the center of the dark spot**

Question 27

what should be done when there is > 25% hematoma in the nail?

Answer 27

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 ## Footnote The nail plate is carefully removed and the hematoma evacuated.

Question 28

suture size for the nail bed

Answer 28

6-0 resorbable monofilament suture

Question 29

main cause of recalcitrant chronic paronychia

Answer 29

Presence of a foreign body (eg, hair) under the proximal nail fold

Question 30

This excision is useful for small distal tumors.

Answer 30

Crescentic excision The crescent should not exceed **4 mm** at its greatest width

Question 31

Ultrasound shows the pathognomonic sign: the **shortening of the distance between the proximal edge of the nail and the distal interphalangial joint.**

Answer 31

Retronychia ## Footnote Retronychia represents proximal regrowth of the nail that occurs when the nail embeds backwards into the proximal nail fold.

Question 32

most common type of ingrown nail.

Answer 32

Juvenile or subcutaneous embedded nail ## Footnote The nail is usually embedded medially, but both sides are often affected.

Question 33

definitive cure for pincer nails

Answer 33

use of phenol cautery on the lateral matrix horns

Question 34

usually the result of long-standing ingrown nails

Answer 34

Hypertrophic lateral nail folds