Nail Surgery

Question 1

where is the nail matrix found?

Answer 1

extends over the base of the distal phalanx to the distal edge of the lunula

Question 2

where is the nail bed found?

Answer 2

distal to the lunula

Question 3

which part of the nail contributes to formation of the nail?

Answer 3

nail matrix, NOT the nail plate

Question 4

the extension of the eponychium is called what?

Answer 4

cuticle

Question 5

80% of the nail is produced by which part of the matrix?

Answer 5

proximal half of the matrix

Question 6

what gives the convex appearance of the nail?

Answer 6

since nail activity is so much higher in the proximal portion, the nail is naturally curved in a convex shape from proximal to distal

Question 7

what is the DuVries method for treating ingrown toe nails?

Answer 7

removing a large section of skin from the side of the toe to relieve soft tissue pressure on the side of the ingrown toenail

Question 8

in a partial and total nail avulsion, is the nail matrix left intact or not?

Answer 8

matrix is left intact

Question 9

what are the ways to perform partial matrixectomies?

Answer 9

1. phenol & alcohol
2. NaOH and acetic acid
3. winograd
4. Frost
5. other matrix ablation techniques

Question 10

which are the ways to perform total matrixectomies?

Answer 10

1. phenol & alcohol (P&A)
2. NaOH
3. Zadik (Quenu)
4. Whitney
5. Kaplan
6. Mini-kaplan
7. terminal Syme

Question 11

which are the ways to perform partial matrixectomies, NOT total matrixectomies?

Answer 11

Winograd & Frost

Question 12

how does NaOH and acetic-acid help with ingrown toe nails?

Answer 12

same as P&A , NaOH helps destroy matrix and is neutralized by 5% acetic acid

Question 13

what is the post-op care for P&A?

Answer 13

• apply dressing w/ silvadene
• keep dry and intact until next morning
• soak in warm water
• air dry
• avoid enclosed shoes for 1 week

Question 14

describe the winograd procedure.

Answer 14

-wedge of skin and nail plate removed down thru matrix to bone with scalpel

Question 15

when would you need to use the winograd procedure?

Answer 15

for patients with chronic ingrown toenail or with hypertrophied nail border

Question 16

Describe the Frost procedure.

Answer 16

“L” shaped - one longitudinal incision thru nail plate extending from tip to skin proximal to nail plate; second incision at right angle to first extending away from nail plate at base of first incision

Question 17

Describe the Zadik (Quenu) procedure.

Answer 17

H-shaped incision made with conecting incision placed proximal to eponychium

Question 18

Which is the L-shaped incision?

Answer 18

Frost

Question 19

What is the H-shpaed incision?

Answer 19

Zadik (Quenu)

Question 20

which is the Whitney technique?

Answer 20

acisional technique that removes nail plate

Question 21

What is the Kaplan technique?

Answer 21

cuts the nail bed right of the bone as well as huge sections of tissue on the side…may as well as amputate the toe

Question 22

what is the terminal syme procedure?

Answer 22

removal of nail plate and matrix down to bone with circumferential incision around nail plate

Question 23

how long should your applications of P&A be?

Answer 23

for partial matrixectomies- do 3 30-second applications

for total - do three 45-sec apps

Question 24

Name 3 procedures that involve rasping bone.

Answer 24

Frost
Winograd
Mini-Kaplan

Question 25

in P&A procedure, which acts as the “rinse”? which destroys the nail matrix?

Answer 25

phenol- destroys matrix

alcohol - acts as the rinse

Question 26

in NaOH and acetic acid, which acts as the “rinse”? which destroys the matrix?

Answer 26

NaOH- destroys matrix

acetic acid- is the rinse

Question 27

Which is the acisional procedure for removing matrix?

Answer 27

Whitney technique