Nail procedure (Pod med)

Question 1

1. what kind of Anxiolytic/ Sedative analgesic can you use for Nail surgery?
2. What’s the amount of LA given to the pt?
3. in what fashion?

Answer 1

1. Penthrox
2. 2ml-4ml
3. in A ring block fashion to the base of the toe

Question 2

What formula do you use to calculate the maximum dose of local aneasthetics?

Answer 2

maximum allowable dose (mg/kg) x (weight in kg/10) x (1/concentration of local anesthetic) = mL

Thus, if maximal dose is 7 mg/kg for lidocaine with epinephrine, using 1% lidocaine with epinephrine for a 60-kg patient:

7 x 6/10 x 1 or

7 x 6 x 1 = 42 mL lidocaine

Question 3

1. What’s the name of the procedure for total nail resection?

Answer 3

1. Zadick

Question 4

1. How does a Zadick incision look like?

Answer 4

Question 5

What are the indications for Winograd?

Answer 5

1. Recurrent IGN
2. Relatively flat nail plate
3. No infection

Question 6

What’s the first step in Winograd technique?

Answer 6

Nail incision with nail splitters +/- # 15 blade

Question 7

What’s the second step in Winograd technique?

Answer 7

Make skin incisions with # 15 blade

Question 8

Third step in Winograd technique?

Disect ….

Answer 8

Dissect out nail section, nail bed and matrix

Question 9

What do you need to curette out?

Answer 9

Curette nail bed and matrix area

over terminal phalanx

Question 10

What are the last steps in Winograd technique?

Answer 10

Irrigate with sterile saline

&

Suture with simple interrupted 4-0 Prolene

Question 11

What are the post-op management for ingrown toenail surgery?

Answer 11

1. Post-op analgesics
2. Instruct patient to keep foot dry
3. Redress in 4-7 days
4. Remove sutures in 7-10 days

Question 12

What are the complications for ingrown toe nail surgery?

1?

2?

3?

4?

5?

Answer 12

1. Pain
2. Infection
3. Hypergranulation tissue
4. Nail spicule regrowth
5. Epidermoid inclusion cyst

Question 13

What are some tips for ingrown toe nail surgery

Answer 13

1. After flushing and before closing → 1-2 drops dexamethasone or inject 2mg with LA
2. After releasing tourniquet wait two minutes before dressing toe
3. Always use paraffin based gauze dressing
4. Tx hypergranulation tissue with AgNO3

Question 14

What are the Phenol after care?

Answer 14

1. Normal shoes
2. Showers OK
3. Dress with Betadine Ointment™
4. Warm salt water sponging daily
5. Re-dress with Betadine Ointment™ and Hypafix or cutiplast daily 2-3 weeks

Question 15

What are the post-op complications?

Common: Rare:

Answer 15

Common: Phenol ‘burn’ with inflammation and drainage & ‘Clogging’ of nail sulcus with fibrin clot preventing normal drainage

Rare: Infection requiring antibiotics, Epidermoid inclusion cyst