Nail Surgery

Minimally Invasive Nail Surgery: Techniques to Improve the Patient Experience

“…The wing block is the preferred technique by many nail surgeons because the second and third injections are given in skin that is already anesthetized, reducing patient discomfort to a single pinprick 11 ; additionally, there is lower postoperative paresthesia risk with the wing block compared with other digital nerve blocks. 12 Ropivacaine, a fast-acting and long-acting anesthetic, is preferred over lidocaine to minimize immediate postoperative pain. Buffering the anesthetic solution to physiologic pH and slow infiltration can reduce pain Minimally Invasive Nail Surgery: Techniques to Improve the Patient Experience during infiltration.…”

“…Buffering the anesthetic solution to physiologic pH and slow infiltration can reduce pain Minimally Invasive Nail Surgery: Techniques to Improve the Patient Experience during infiltration. 12 Distraction 12 provided by ethyl chloride refrigerant spray, an air-cooling device, 13 or vibration also can reduce pain during anesthesia.…”

“…The punch biopsy is a minimally invasive method for diagnosing various neoplastic and inflammatory nail unit conditions, except for pigmented lesions. 12 For polydactylous nail conditions requiring biopsy, a digit on the nondominant hand should be selected if possible. The punch is applied directly to the nail plate and twisted with downward pressure until the bone is reached, with the instrument withdrawn slowly to prevent surrounding nail plate detachment.…”

“…Pushing the cuticle with an elevator/spatula instead of making 2 tangential incisions on the proximal nail fold has been suggested to decrease postoperative paronychia risk. 12 A Teflon-coated blade is used to achieve a smooth cut with minimal drag, enabling collection of specimens less than 1 mm thick, which provides sufficient nail matrix epithelium and dermis for histologic examination. 16 After obtaining the specimen, the avulsed nail plate may be sutured back to the nail bed using a rapidly absorbable suture such as polyglactin 910, serving as a temporary biological dressing and splint for the nail unit during healing.…”

“…16 After obtaining the specimen, the avulsed nail plate may be sutured back to the nail bed using a rapidly absorbable suture such as polyglactin 910, serving as a temporary biological dressing and splint for the nail unit during healing. 12 In a retrospective study of 30 patients with longitudinal melanonychia undergoing tangential matrix excision, 27% (8/30) developed postoperative onychodystrophy. 17 Although this technique carries relatively lower risk of permanent onychodystrophy compared to other methods, it still is important to acknowledge during the preoperative consent process.…”