Onychocryptosis
What is the Frost procedure?
"L" shaped incision behind nail plate Excise the nail root (penetrate epi, dermis, and subcutaneous tissue)
What individuals are at risk for nail surgical procedures?
Allergy to local anesthetics Coagulapathy Pregnancy PAD
Involves sharp partial or total excision of the nail matrix and/or the nail bed
Cold steel procedures
What is the Winograd procedure?
D shaped excision of nail root and overlying tissues Semi-elliptical incision
Distal ring of tissue develops and nail growth blocked by hyponychium; allows dorsal (upward) expansion of nail
Distal nail embedding
Are oral antibiotics necessary in the treatment of locally infected ingrown toenails?
Do not play a role in decreasing healing time or post-procedure morbidity
What supplies the medial side of the great toe dorsally?
Dorsal digital branches (from medial and dorsal cutaneous nerves)
What is Stage 1 of onychocryptosis?
End of toe red with mild swelling May feel warm and painful to touch No pus/drainage
What instrument is used to split the nail plate?
English Anvil
What are individuals with PAD defined as?
Exertional leg symptoms Non-healing wounds 65 y/o + 50 y/o + with hx of smoking or diabetes < 50 y/o with diabetes and one addtnl risk factor
T/F: Glomus tumor is malignant
FALSE -- benign tumor but painful
What procedure is used for subungual exostosis?
Fowler procedure
What are types of partial nail excision procedures?
Frost Winograd
Tender, red, subungual nodule or small, subtle area of blue pigmentation
Glomus tumor
What is the Zadik procedure?
H shaped incision Excision of entire nail matrix and nail bed
Characterized by an overgrowth of soft tissue of the internal portion of the lateral nail fold
Hypertrophy of lateral nail fold
What is the Fowler procedure?
Incision angles ~45 degrees from nail border Excision just at nail root
What is Stage 2 of Onychocryptosis?
Increasingly red, swollen and painful Maybe white or yellow colored pus or drainage Infection may have developed
What is onychocryptosis?
Ingrown toenail -- painful cut of nail into surrounding skin causing inflammatory reaction
What is the Whitney procedure?
Inverted L on BOTH SIDES (nail borders) *similar to Frost*
Impingement of nail plate onto nail fold due to improper nail cutting; spicule pierces soft tissue
Juvenile Ingrown Toenail
What are the multiple clinical presentations of onychocryptosis?
Juvenile ingrown Hypertrophy of nail fold Pincer/Involuted nail Distal nail embedding
What are hallux blocks used for?
Onychocryptosis Paronycha Skin biopsy Closed reduction
Which group showed less pain and earlier pain relief between cold steel vs. phenol procedures?
Phenol group
Nail plate displays an excessive curvature, especially in distal portion Results in compression of distal nail bed with severe pain
Pincer Nail (Trumpet Nail/Omega nail/ Involuted nail)
What type of clinical presentation of onychocryphosis are good candidates for surgical correction?
Pincer nails
What supplies the skin on the medial side of the great toe?
Proper digital nerve of great toe
Lobar capillary hemangioma; common benign vascular lesion of skin and mucosa
Pyogenic Granuloma
What is Stage 3 of Onychocryptosis?
Redness, swelling and pain increased Granulation tissue adds to swelling and discharge Lateral nail fold hypertrophy More severe infection; fever
What agents are used for granuloma management?
Silver nitrate Lumican (coagulant)
Subungual pigmentation that does not move distally as the nail plate grows Locally destructive; highly metastatic
Subungual/ Periungual melanoma
Procedure used in the belief that the nail matrix is all emcompassing around the nail base
Suppan procedure
How should the hemostat be rotated to removed the nail piece?
TOWARDS THE NAIL while pulling straight out toward end of toe
T/F: Sodium hydroxide causes less postop morbidity and provides faster recovery than phenol
TRUE
What supplies the adjacent sides of the great and second toes?
Terminal branch of deep peroneal nerve
What is Hutchinson's sign?
Think Melanoma Spilling over into skin/adjacent nail folds
What type of excision procedure is used for patient with hypertrophied borders?
Winograd procedure
What are types of total nail excision procedures?
Zadik Whitney Fowler Kaplan Suppan Terminal symes
Where is a hallux block injected?
distal to 1st MPJ
Describe the directions of injection for the hallux block procedure?
dm to pm, dm to dl, dl to pl
What is the underlying cause of ingrown toenails? what type of HS reaction?
foreign body reaction Type IV
What is onychophosis?
hyperkeratotic tissue develops on lateral or proximal nail fold between folds and nail plate
What portion of the matrix contributes to the top layer of the nail plate?
proximal portion (distal portion = ventral side of nail)
What is a true exostosis?
something falls on top of nail/trauma produces more bone --> painful
