Managing Bleeding in Nail Surgery: Pre-, Intra-, and Postoperative Hemostasis Strategies

Conclusions

• Effective management of bleeding in nail surgery depends on anticipating risk before the procedure, especially by screening for bleeding disorders and medication or supplement use.
• Patients with suspected bleeding diatheses should be co-managed with hematology, while anticoagulants and antiplatelet agents are often continued because thrombotic risk may outweigh the modest bleeding risk.
• Supplements and natural products that can increase bleeding should be specifically asked about and usually stopped before surgery.
• During nail surgery, chemical hemostasis can be achieved with epinephrine or tranexamic acid, and epinephrine is generally safe in digital surgery despite long-standing concerns.
• Tourniquets remain highly useful for creating a bloodless field, but they should be used with the lowest effective pressure and removed promptly by the person who applied them.
• After surgery, topical hemostatic agents such as aluminum chloride, brimonidine, vasoconstrictors, and oxidized regenerated cellulose can help control minor bleeding.
• Monsel’s solution may be effective but is less favored in nail surgery because it can interfere with later assessment of nail pigmentation.
• For heavier postoperative bleeding, pressure, sutures, volumetric tourniquet techniques, and bulky dressings are the most useful mechanical strategies.
• Simple mechanical measures like proper dressings and early follow-up can reduce bleeding-related complications and improve outcomes.
• Overall, the presentation argues that bleeding in nail surgery is manageable with a stepwise approach before, during, and after surgery using the least invasive effective method.