AAD
Author: Willhemenia Loremipsum Special session: Lorem ipsum dolor sit amet Category: Lorem ipsum View all results

Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

  • Presentation

Treating Complications in Nail Surgery

Description

The presentation discusses managing complications in nail surgery, highlighting that complications like bleeding, infection, and necrosis are common. Bleeding can lead to hematoma, which is managed through bulk dressing and elevation, while oxidized cellulose can enhance clotting. Infection is rare but typically a result of poor nail hygiene; patients are advised to maintain cleanliness, using soap and water. Special attention is needed for patients with impaired blood supply or chronic conditions like diabetes. Specific complications such as nail dystrophy and lateral deviation occur due to improper techniques, often related to the removal of the matrix or inadequate postoperative care. Pain management is critical, requiring potent analgesics and limb elevation for recovery. Techniques like tangent excision and refining surgical approaches can minimize complications. The speaker emphasizes the importance of proper incision techniques, using the right tools to remove nail components, and consulting a plastic surgeon for severe necrosis. Additionally, the healing process can take time, with nail regrowth occurring over cycles. Surgeons are encouraged to read and familiarize themselves with procedures to enhance confidence and skill in nail surgery.

View more

Conclusions

  • Bleeding is the most common complication in nail surgery, often managed with bulky dressings and elevation.
  • Infection rates in nail surgery are low, but proper hygiene before and after surgery is crucial.
  • Necrosis can occur due to tight sutures or excessive anesthesia; avoiding epinephrine is advisable for nail surgeries.
  • Smokers are four times more likely to experience complications, highlighting the importance of cessation for better outcomes.
  • Inclusion cysts are rare and typically associated with grafting procedures rather than routine nail surgery.
  • Hypertrophic scars and keloids are uncommon after nail surgery, even in patients with darker skin.
  • Dysesthesia is a frequent postoperative issue, affecting nearly 50% of patients, but often resolves within six to twelve months.
  • Lateral deviation of the nail can result from incomplete excision of the matrix, stressing the importance of proper technique during surgery.
  • Spicules can develop following matrix displacement during surgery, emphasizing the need for thorough removal of the lateral horn.
  • Nail dystrophy can occur after matrix surgeries, but using tangential excision techniques can minimize this risk.
  • Distal embedding and recurrence of nail issues can happen if excisions are incomplete, necessitating careful surgical planning.
  • Complex regional pain syndrome is rare after nail surgery, making it a less common concern in practice.
  • Yang G, Yanchar NL, Lo AY, Jones SA. Treatment of ingrown toenails in the pediatric population. J Pediatr Surg.
  • Terrill AJ, Green KJ, Salerno A, Butterworth PA. Risk factors for infection following ingrowing toenail surgery: a retrospective cohort study. J Foot Ankle Res. 2020;13(1):48.
  • Metcalfe D, Aquilina AL, Hedley HM. Prophylactic antibiotics in open distal phalanx fractures: systematic review and meta-analysis. J Hand Surg Eur.
  • Modha MRK, Morriss-Roberts C, Smither M, Larholt J, Reilly I. Antibiotic prophylaxis in foot and ankle surgery: a systematic review of the literature. J Foot Ankle Res. 2018; 15;11:61.
  • Bettin CC, Gower K, McCormick K et al. Cigarette smoking increases complication rate in forefoot surgery. Foot Ankle Int. 2015;36:488-93.
  • Lazar A, Abimelec P, Dumontier C. Full thickness skin graft for nail unit reconstruction. J Hand Surg Br. 2005;30:194-8.
  • Wadhams PS, McDonald JF, Jenkin WM. Epidermal inclusion cysts as a complication of nail surgery. J Am Podiatr Med Assoc. 1990.
  • Fonia A, Richert B. Onychalgia Causes and Mechanisms: The "GIFTED KID" and the "FOMITE". Skin Appendage Disord. 2020;6:77-87.
  • Walsh M, Shipley DV, de Berker DAR. Clin Exp Dermatol 2009;34:154-156.
  • De Berker DAR, Baran R. Acquired malalignment: a complication of lateral longitudinal nail biopsy. Acta Derm Venereol. 1998;78:468-70.
  • Richert B, Dahdah M. Complications in Nail Surgery. In: Noury K. Complications in dermatologic surgery. Elsevier 2008; pp138-158.
  • Koenen W, Haneke E, Schmieder A. Nail substitute with a syringe splint. J Dtsch Dermatol Ges. 2010 Jan;8(1):63-4.
  • Jellinek NJ, Cressey BD. Nail Splint to Prevent Pterygium After Nail Surgery. Dermatol Surg. 2019;45(12):1733-1735.