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Dermatology
Nail Surgery
Built from Dermatology, 5th Edition
What’s inside
13 sections · 79 slides
Overview
- What this topic covers
Introduction
Why nail surgery needs its own anatomy, technique, and pathology expertise
- Why dermatologists perform nail surgery
- Prerequisites for successful nail surgery.
Surgical Anatomy of the Nail Unit
The parts of the nail unit, their blood supply, and their nerve supply
- Components of the nail unit
- The five parts of the nail unit
- The nail matrix and nail plate thickness
- The nail matrix and its production of the nail plate
- The nail bed, hyponychium, and nail folds
- How a damaged seal leads to infection
- Nerve and blood supply of the digit
- Surgical anatomy of the nail unit: blood vessels and nerves
Preoperative Evaluation and Patient Preparation
Screening, imaging, and the informed-consent discussion before surgery
- What to screen for before nail surgery
- Consent and preparation
- Patient evaluation prior to nail surgery.
- Patient evaluation prior to nail surgery. (continued)
Anesthesia of the Nail Unit
Local anesthetic choice, injection technique, and reducing injection pain
- Choosing a local anesthetic
- Distal digital nerve block
- The wing procedure (infiltrative anesthesia)
- Injection sites for the digital nerve block and the wing procedure
Instruments for Nail Surgery
The elevator, nippers, and tourniquet options unique to nail surgery
- Nail elevators and nippers
- Types of nail elevators
- Sharp-pointed and beveled nail nippers
- Getting a bloodless field: the tourniquet
- Sterile glove used as a tourniquet and sterile field
Nail Plate Avulsion
Removing the nail plate to expose the bed and matrix for treatment
- Why and when to remove the nail plate
- Distal nail plate avulsion: technique
- Distal nail plate avulsion, step by step
- Exposing the matrix, and uses of partial avulsion
- Lateral avulsion to expose a nail bed lesion
- Treating a dermatophytoma by partial avulsion
Biopsy Techniques
Matching the incision to where the pathology sits within the nail unit
- General rules for nail biopsy
- Types and orientations of nail unit biopsies and excisions
- Nail bed biopsy
- Clinical features of nail bed disorders in which a biopsy may facilitate diagnosis and subsequent treatment.
- Clinical features of nail bed disorders in which a biopsy may facilitate diagnosis and subsequent treatment. (continued)
- Clinical features of nail bed disorders in which a biopsy may facilitate diagnosis and subsequent treatment. (continued)
- Nail bed biopsy: punch versus longitudinal excisional biopsy
- Nail matrix biopsy: why it is done
- Choosing the matrix biopsy technique
- Surgical approach to longitudinal melanonychia
- Pseudo-Hutchinson sign
- Etiologies of a pseudo-Hutchinson sign.
- Lateral longitudinal biopsy
- Lateral longitudinal biopsy technique
- A complication of incomplete removal: nail spicules
- Nail spicule from incomplete matrix removal
- Proximal nail fold biopsy
- Proximal nail fold biopsy via a crescent-shaped incision
Surgical Procedures for Disorders of the Nail Unit
Techniques for paronychia, ingrown nails, and nail unit tumors
- Acute paronychia
- Surgical drainage of acute paronychia
- Chronic paronychia: two surgical options
- Surgical treatment of chronic paronychia
- Ingrown toenail: two surgical strategies
- Two strategies for ingrown toenails
- Chemical matricectomy with phenol
- Phenol technique and safety
- Chemical cauterization of the matrix for an ingrown nail
- Nail unit tumors and cysts
- Exposing a glomus tumor in the proximal nail matrix
- Removing a nail bed glomus tumor, step by step
- Onychomatricoma and digital myxoid cyst
- Squamous cell carcinoma and melanoma of the nail unit
- Nail unit tumors: radiographic findings and surgical treatments.
- Controlling bleeding after nail surgery
Postoperative Care
Dressings, pain control, and instructions that reduce complications
- Dressing the wound
- Pain control and aftercare instructions
Complications of Nail Surgery
General surgical risks plus problems unique to the nail unit
- General complications
- Complications specific to the nail unit
- Complications of nail surgery.
Summary
Pulling the nail surgery toolkit together
- Key takeaways
References
Source citations from the chapter
- References
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- References (continued)
- Dermatology, 5th Edition (2-Volume Set)