Advertisement

Nail Surgery Overview and Approach

  • Nathaniel J. Jellinek
  • Ali Damavandy
  • Jeremy R. Etzkorn
  • Joseph F. Sobanko
  • Thuzar M. Shin
  • Christopher J. Miller

Abstract

Nail surgery represents a fundamental subset of dermatologic surgery. Nearly every cutaneous condition and tumor may develop on the nail unit – frequently the practitioner will find the need to perform a surgical procedure on or around the nail, for either diagnosis or as a part of therapy. Successful surgery requires an understanding of the unique nail anatomy, appropriate surgical consent, complete anesthesia, and often manipulation of the plate and/or nail folds to achieve adequate surgical exposure. When armed with tools that address these issues, nail surgery becomes as straightforward as that on the skin.

Keywords

Nail surgery Avulsion Digital block Anesthesia Nerve block Anatomy Dressings Wound care Informed consent 

Supplementary material

978-3-319-65649-6_33_MOESM1_ESM.pdf (32 kb)
Patient Handout (PDF 32 kb)

References

  1. 1.
    Shum C, et al. Examination of the anatomic relationship of the proximal germinal nail matrix to the extensor tendon insertion. J Hand Surg [Am]. 2000;25(6):1114–7.Google Scholar
  2. 2.
    Sonnex TS, Griffiths WA, Nicol WJ. The nature and significance of the transverse white band of human nails. Semin Dermatol. 1991;10(1):12–6.PubMedPubMedCentralGoogle Scholar
  3. 3.
    De Berker D, Mawhinney B, Sviland L. Quantification of regional matrix nail production. Br J Dermatol. 1996;134(6):1083–6.Google Scholar
  4. 4.
    Haneke E. Anatomy of the nail unit and the nail biopsy. Semin Cutan Med Surg. 2015;34(2):95–100.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Haneke E. Surgical anatomy of the nail apparatus. Dermatol Clin. 2006;24(3):291–6.PubMedGoogle Scholar
  6. 6.
    de Berker D. Nail anatomy. Clin Dermatol. 2013;31(5):509–15.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Walsh ML, Shipley DV, de Berker DA. Survey of patients’ experiences after nail surgery. Clin Exp Dermatol. 2009;34(5):e154–6.PubMedGoogle Scholar
  8. 8.
    Ingram GJ, Scher RK, Lally EV. Reflex sympathetic dystrophy following nail biopsy. J Am Acad Dermatol. 1987;16(1 Pt 2):253–6.PubMedGoogle Scholar
  9. 9.
    Jellinek NJ, Velez NF. Nail surgery: best way to obtain effective anesthesia. Dermatol Clin. 2015;33(2):265–71.PubMedGoogle Scholar
  10. 10.
    Chowdhry S, et al. Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg. 2010;126(6):2031–4.PubMedGoogle Scholar
  11. 11.
    Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg. 2001;108(1):114–24.PubMedGoogle Scholar
  12. 12.
    Katis PG. Epinephrine in digital blocks: refuting dogma. CJEM. 2003;5(4):245–6.PubMedGoogle Scholar
  13. 13.
    Krunic AL, et al. Digital anesthesia with epinephrine: an old myth revisited. J Am Acad Dermatol. 2004;51(5):755–9.PubMedGoogle Scholar
  14. 14.
    Lalonde D, et al. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg Am. 2005;30(5):1061–7.PubMedGoogle Scholar
  15. 15.
    Mann T, Hammert WC. Epinephrine and hand surgery. J Hand Surg Am. 2012;37(6):1254–6. quiz 1257.PubMedGoogle Scholar
  16. 16.
    Muck AE, et al. Six years of epinephrine digital injections: absence of significant local or systemic effects. Ann Emerg Med. 56(3):270–4.PubMedGoogle Scholar
  17. 17.
    Thomson CJ, et al. A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg. 2007;119(1):260–6.PubMedGoogle Scholar
  18. 18.
    Wilhelmi BJ, et al. Do not use epinephrine in digital blocks: myth or truth? Plast Reconstr Surg. 2001;107(2):393–7.PubMedGoogle Scholar
  19. 19.
    Fulling PD, Peterfreund RA. Alkalinization and precipitation characteristics of 0.2% ropivacaine. Reg Anesth Pain Med. 2000;25(5):518–21.PubMedGoogle Scholar
  20. 20.
    Becerro de Bengoa Vallejo R, et al. Preoperative skin and nail preparation of the foot: comparison of the efficacy of 4 different methods in reducing bacterial load. J Am Acad Dermatol. 2009;61(6):986–92.PubMedGoogle Scholar
  21. 21.
    W-Dahl A, Toksvig-Larsen S. Pin site care in external fixation sodium chloride or chlorhexidine solution as a cleansing agent. Arch Orthop Trauma Surg. 2004;124(8):555–8.PubMedGoogle Scholar
  22. 22.
    Bibbo C, et al. Chlorhexidine provides superior skin decontamination in foot and ankle surgery: a prospective randomized study. Clin Orthop Relat Res. 2005;438:204–8.PubMedGoogle Scholar
  23. 23.
    Keblish DJ, et al. Preoperative skin preparation of the foot and ankle: bristles and alcohol are better. J Bone Joint Surg Am. 2005;87(5):986–92.PubMedGoogle Scholar
  24. 24.
    Wolf EW, Hodge W, Spielfogel WD. Periungual bacterial flora in the human foot. J Foot Surg. 1991;30(3):253–63.PubMedGoogle Scholar
  25. 25.
    Becerro De Bengoa Vallejo R, et al. Efficacy of preoperative and intraoperative skin and nail surgical preparation of the foot in reducing bacterial load. Dermatol Surg. 2010;36(8):1258–65.PubMedGoogle Scholar
  26. 26.
    Hunter JG, et al. Randomized, prospective study of the order of preoperative preparation solutions for patients undergoing foot and ankle orthopedic surgery. Foot Ankle Int. 2016;37(5):478–82.PubMedGoogle Scholar
  27. 27.
    Harrington AC, et al. A novel digital tourniquet using a sterile glove and hemostat. Dermatol Surg. 2004;30(7):1065–7.PubMedGoogle Scholar
  28. 28.
    Lahham S, et al. Comparison of pressures applied by digital tourniquets in the emergency department. West J Emerg Med. 2011;12(2):242–9.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Hart WJ, Wagner W. A simple and fail safe method for digital tourniquet. J Hand Surg Br. 2003;28(2):190. author reply 190.PubMedGoogle Scholar
  30. 30.
    National Patient Safety Agency, UK. Reducing risks of tourniquets left on after finger and toe surgery. 2009.Google Scholar
  31. 31.
    Jellinek NJ. Commentary: how much is too much? Tourniquets and digital ischemia. Dermatol Surg. 2013;39(4):593–5.PubMedGoogle Scholar
  32. 32.
    Cox C, Yao J. Tourniquet usage in upper extremity surgery. J Hand Surg Am. 2012;35(8):1360–1.Google Scholar
  33. 33.
    Collins SC, Cordova K, Jellinek NJ. Alternatives to complete nail plate avulsion. J Am Acad Dermatol. 2008;59(4):619–26.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Jellinek NJ. Nail matrix biopsy of longitudinal melanonychia: diagnostic algorithm including the matrix shave biopsy. J Am Acad Dermatol. 2006. in press (accepted).Google Scholar
  35. 35.
    de Berker DAR. Trap door nail avulsion to minimise trauma in nail surgery when accessing the nail bed and matrix. Br J Dermatol. 2006;155(s1):100.Google Scholar
  36. 36.
    Kang BS, Na YC, Jin YW. Comparison of the wound healing effect of cellulose and gelatin: an in vivo study. Arch Plast Surg. 2012;39(4):317–21.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Abimelec P, Dumontier C. Basic and advanced nail surgery (Part 2: Indications and Complications). In: Scher RK, Daniel CR, editors. Nails: diagnosis, therapy, surgery. Elsevier Saunders; 2005. p. 291–308.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nathaniel J. Jellinek
    • 1
    • 2
    • 3
  • Ali Damavandy
    • 4
  • Jeremy R. Etzkorn
    • 4
  • Joseph F. Sobanko
    • 4
  • Thuzar M. Shin
    • 4
  • Christopher J. Miller
    • 4
  1. 1.Dermatology Professionals, Inc.East GreenwichUSA
  2. 2.Department of DermatologyThe Warren Alpert Medical School at Brown UniversityProvidenceUSA
  3. 3.Department of DermatologyUniversity of Massachusetts Medical SchoolWorcesterUSA
  4. 4.University of Pennsylvania, Department of DermatologyPhiladelphiaUSA

Personalised recommendations