Bologna CH149 Nail Surg Flashcards
The nail bed, aka the sterile matrix, extends from the distal lanula to the hyponychium
True
A rich vascular supply leads to the pink colour that is visible through the translucent nail plate
True
Surgery of the nail bed commonly leads to nail dystrophy
False rare
Surgery of the nail bed may result in mild onycholysis
True
Hyponychium is where the nail plate detaches to form its free edge
True
Disruption of the hyponychium by trauma or disease can result in onycholysis , followed by bacterial and fungal contamination
True
Proximal nail fold protects most of the matrix and newly formed plate
True
The perionychium is the paronychium + hyponychium + nail matrix
False - nail bed not nail matrix
The index, middle and ring fingertips are innervated by the dorsal digital nerves whilst the thumb and little finger are innervated by the palmar nerves
False — 2, 3, 4 innervated by palmar and 1 , 5 innervated by dorsal
Paired proper digital arteries run along the lateral and volar sides of the digit
True
Nail nippers are essential for cutting the nail plate
True
Nail surgery does not require a bloodless surgical field
False
Tourniquet for the digit can be applied for a maximum of 30 min
True
Steps in Removal of glomus tumour
- written procedural , financial consent
- discuss risks: bleed, infection, scarring, nail dystrophy, compartment syndrome, digital ischaemia
- digital ring and wing block with tourniquet application , start timer
- sterile field
- two oblique incisions at junction of the lateral and proximal nail folds,
- retraction of the proximal nail fold
- lateral AVULSION of the plate
- visualise tumour in nail matrix and excise
- replace proximal nail fold and insert sutures 4-0 silk
- pressure dressing and splint
- close follow up with review of wound and remove sutures in 10 days
Within the nail bed, the incision should be oriented horizontally, whereas within the matrix it should be oriented longitudinally
False
Nail bed incision longitudinal
Matrix excision horizontal
Nail bed bx has one major indication - determination of the cause of longitudinal melanonychia
True
If pigment origin has longitudinal orientation, narrow elliptical ellipse down to bone is recommended
True
Lateral longitudinal nail biopsy narrows the nail permanently due to complete amputation of the lateral matrix horn
False partial amputation
Chronic paronychia that is recalcitrant may be treated with en bloc excision of proximal nail fold , from one lateral nail fold to the other
True
What are the two major surgical approaches for an ingrown toenail
1 - narrow the nail plate via lateral matricectomy via chemical cautery phenol 88%
2 - debulking surrounding soft tissues
Phenol has 3 relevant properties - necrotising, disinfecting and absorptive
False , anaesthetic rather than absorptive
Phenol induces a very uncomfortable post op period
False - very comfortable as it induces demyelination of terminal nerve endings for several weeks
How to perform a lateral longitudinal matricectomy
After anaesthesia established, place tourniquet to ensure completely bloodless field
- curette any granulation tissue for a better view of the lateral part of the nail plate
- avulse lateral or bilateral strip of nail plate 3-5mm in width up to its origin under the proximal nail fold
- phenol 88% is applied onto the exposed lateral horn of the matrix and bed with a wisp of cotton wool/urethral swab or elevator itself
—> do not oversoak cotton as may result in cauterant spilling onto periungal tissue
- ideal application time is 2-3 min
Rinsing with alcohol can neutralise phenol
False, only dilutes it
Phenol is unsafe in diabetics and children
False, safe
Phenol is unhelpful in recaltricant ingrown toenails from EGFR inhibitors
False, it is helpful
