wk 6- different nail types and surgeries Flashcards
anatomy of nail
nail plate (the actual nail)
lunula (white semi circle)
nail fold/cuticle (skin on proximal edge)
nail matrix (proximal to nail plate under the skin)
nail bed (distal to nail matrix, under the nail plate)
how far does the matrix extend
proximal to the EHL insertion and distal to the plantar aspect of distal phalanx
how much does the nail bed contribute to the nail plate
10%
what are causes of ingrown nails
-cutting technique
-intrinsic foot abnormalities (involuted nails, hyperextension of hallux, HAV, pes planus)
-geriatric
-medications
-systemic conditions (obesity, DM, arthritis
-onychomycosis
-trauma
-hyperhydrosis
-footwear
-genetics (hereditary)
what is the academic word for ingrown nail
onychocryptosis (OC)
classification of OC
stage 1- redness, slight swelling, pain (nail fold doesnt exceed nail plate)
stage 2-
a: pain, swelling, redness, serum drainage and or infection (nail fold exceeds nail plate <3mm)
b: (nail fold exceeds plate >3mm)
stage 3- granulation tissue and chronic hypertrophy of nail fold covering nail plate
stage 4- serious deformity of nail, both nail folds, and distal fold, hypertrophic tissue covering all edges
conservative treatment of ingrowns
-nail packing with cotton wool to separate nail fold from nail plate
-toe taping to pull nail fold away from nail plate
-cut nails straight across
-avoid tight footwear
-nail bracing
what investigations should be made if theres a subungal mass
x ray
AP, isloated lateral view
if concerned about vascular supply what investigations should be taken
ABI/TPI
regular HBA1c if DM
what is mg/kg for lignocaine
3mg/kg
PNA means
partial nail avulsion
P and A means
phenol and alcohol
TNA means
total nail avulsion
NER means
nail edge resection
sites for surgery can be
fibular edge (lateral)
or
tibial edge (medial)
using phenol pros/cons
reduces risk of recurrence but increased risk of infection
different types of nail surgery
- nail wedge avulsion- no chemical
-partial, total - chemical matrixectomy
-partial, total - excisional matrixectomy
-partial, total, subungal exostectomy
what changes can you make to the surgery
- tournicot use
- length of chemical use
- method of application
- neutralising agent use
- post op dressing
what is chemical nail surgery indicated in
nail plate only deformity