Nail surgery Flashcards
What are the layers of tissue taken from a punch biopsy of the nail matrix or nail bed?
Epidermis, dermis, periosteum. The key is there is NO SUBCUTIS
What histologic difference is apparent in the nail bed within the epidermis?
Lacks a granular cell layer
What tool is used as a nail elevator during nail avulsions but inserting under the proximal nail fold and moving it back and forth to detach the plate?
The Freer septum elevator (make sure and look up pictures of these! they often ask by showing the tool)
When is a distal nail avulsion used?
When the area of the lesion is known or there is significant sub-ungual debris/hyperkeratosis (don’t need to remove all the way to matrix)
If a subungual melanoma is suspected, where should the biopsy be performed? What technique is required)
The nail matrix must be biopsied
Technique: horizontal biopsy of the distal matrix (if possible. These are usually under the nail, remember that the distal matrix –> ventral nail, also avoids more severe nail dystrophy than if the proximal matrix is bx
What is the most commonly used nail avulsion technique?
Distal nail avulsions –> entire nails is removed from distal nail bed to proximal nail fold
Up to what size of nailbed excision can be performed without using sutures?
Longitudinal excision of the nail bed can be performed with a width up to 3mm before sutures are needed
What type of excision is done in the nail bed as opposed to the nail matrix?
Nail bed = longitudinal
Nail matrix = horizontal
Which types of nail biopsies carry the highest risk of nail dystrophy, thinning, etc?
Proximal nail matrix biopsies (as opposed to distal) and biopsies >3mm
Where can lateral longitudinal excisions be used on the nail?
Lesions on the lateral portion of the nail fold, proximal nails fold, or on the lateral portions of the matrix/nail bed
What is the primary risk of a longitudinal nail biopsy?
Spicule or cyst formation
What are the indications for nail matricectemy?
Ingrown nail/onychocryptosis is the most common
-Also onychomadesis
With ingrown nails, if matricectomy is needed, should the whole matrix be removed?
Generally, just the part of the matrix that is involved in the problem should try to be removed, sparing the rest
How far proximal on the finger must an excision be taken to completely remove the nail matrix, and when would this be performed?
Excision of the nail unit requires that the excision be taken to the DIP tendon insertion point
This type of procedure is done for the removal of malignant tissue such as a subungual melanoma
What is an important functional side effect that can occur with nail unit excision?
Joint stiffness
