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85 Cards in this Set
- Front
- Back
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The nail tissue is derived from
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Ectoderm
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What is it called on the side of the nail where it bends down towards the side of the toe?
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lateral nail fold
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What is the white part on the nail?
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Nail plate, Lunula
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The nail plate r lunula pushes out into "what"?
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The nail field.
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What is the pt of the nail at the distal end, inferior side, where it contacts the epidermis of the toe?
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The hyponichium
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What makes the nail so hard?
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Low water content, high sulfur content
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Nail functions to do what to tactile sense? Why?
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Nail augmetnts tactiel function by allowing for counter pressure during touch.
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What is the cellular makeup of the nail?
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it is a specialized Keratinized appendage
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Onychauxis
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Onychauxis presents with thickened nails without deformity, and this simple thickening may be the result of trauma, acromegaly, Darier's disease, psoriasis, or pityriasis rubra pilaris, or, in some cases, hereditary.[1]:783[2]
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Onychomycosis
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means fungal infection of the nail
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What sort of problems may require nail surgery?
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Onychauxis, onychomycosis, Diabetes mellitus, trauma, PVD, crummy environment,
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Onychogryphosis
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Rams horn growth of the fingernail
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Onychocryptosis
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Ingrown toenail
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What are the 6 etiologies of onychocryptosis?
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Trauma/microtrauma
Improper self care Congenital, osteochondroma/SUX Ill fitting Shoes |
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Paronychia
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The nail disease paronychia , is an often-tender bacterial or fungal hand infection or foot infection where the nail and skin meet at the side or the base of a finger or toenail. The infection can start suddenly (acute paronychia) or gradually (chronic paronychia).
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term for this appearane?
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Subungual Hematoma
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Pt Presents with this. Be sure to ? Why?
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Sub-ungual Hematoma, Xray, >50% of nail damaged should be examined for fractures
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Sub-Ungual Hematoma Etiologies?
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Trauma/microtrauma
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A pt presents with a subungual hematoma >50% of the nail, What is statistically involved, and what other dx should you consider?
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Generally >50%= fracture, should think nail bed laceration
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What is the most common skin cancer among people with deeper skin color?
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Acryl-lentiginous Melanoma
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Where does Acryl-Lentiginous Melanoma usually develop? What is its appearance?
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Palms, Soles, Nails, Appears brown or black with irregular boders
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Hutchinsons's sign is usually associated with what disease? what is the appearance?
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Acryl-lentiginous Melanoma, Spread of pigment into nail fold with resultant longitudinal dark stripe
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What is Black Heel? What causes it?
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punctuate hemorrhages on the heels of athleets who pay sports that involve frequent starts and stops. Resolves on its own.
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What are three trademark signs of psoriatic nails?
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Pitting, Oil Spots, Lysing
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What pre-op antibacterial is mentioned in lecture?
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Betadine swabsticks
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What is Dr. Jenkin's favorite tool for hemostasis?
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Tornicot
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What instrumentation is used in ingrown toenail procedures, in the proper order.
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Spatula or Freer elevator
English anvil Beaver w/ #62 blade Hemostat Curette Q-tip (for matrixectomy) |
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Possible diagnosis?
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Psoriatic nails (actual)
could be fungal infection- (review pt. history) |
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What dis?
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English Anvil/nial splitter
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What are the indications for a partial nail avulsion?
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Acute onychocryptosis
where only the borders are pathologic Stage I for a II part permanent procedure (depending on infxn) |
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According to Dr. Jenkins: should you wear gloves when giving injections, as if they are impermeable to needles.
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YES!!!
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Partial matrixectomy - ???= Partial evulsion
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Acid
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Indications for a total nail avulsion?
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Entire nail is pathologic
Underlying injuries (S.H, Laceration) nail bed lesion (melanoma) SUX sx |
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What underlying nail injuries would be indicative of a total nail avulsion?
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An enromo subungual hematoma,
A laceration to nail bed |
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What are the two Sx that are listed as indicative of total nail avulsion in the lecture?
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Part of tumor removal,
Distal symes amputation |
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What are some Diseases that may necessitate a total avulsion?
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onychomycosis,
psoriatic nails onychogryphosis |
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Indications of a partial matrixectomy
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only nail borders are pathologic
CHRONIC onychryptosis? site generally non-infected When permanent change is preffered. |
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What is a matrixectomy?
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Permanent remvoal of the matrix for all or a portion of the nail
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What are some methods of destroying matrix cells in matrixectomy?
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Surgical excision, chemical cauterization, laser, cryotherapy, radio waves (like AM radio ?!?)
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What are the two common chemicals used in matrixectomies?
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Phenol
Sodium Hydroxide |
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How do you dilute the two most common chemcals used in matrixectomies
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Phenol- Alcohol
Sodium Hydroxide- Vinegar |
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What is the application schedule for Phenol vs NaoH?
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3x60
vs 1x45 |
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Most general post op instructions.
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Keep clean and dry
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What are the two common chemicals used in matrixectomies?
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Phenol
Sodium Hydroxide |
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Post-op Saline soak routine?
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3x/day
20min each 1Tblsp NaCL/ 1qt H2O then cover that thang! |
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How do you dilute the two most common chemcals used in matrixectomies
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Phenol- Alcohol
Sodium Hydroxide- Vinegar |
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Does everyone have to soak post op?
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Yes... I mean, no.
could simply apply topical antibiotics and/or corticosteroids Can use antibacterial gels also |
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What is the application schedule for Phenol vs NaoH?
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3x60
vs 1x45 |
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what is the activity recommendation post Nail op?
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Activity as tolerated.
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Most general post op instructions.
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Keep clean and dry
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What is routine recommendation for pain post nail-op?
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Acetominaphen or ibuprofen are adequate
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Post-op Saline soak routine?
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3x/day
20min each 1Tblsp NaCL/ 1qt H2O then cover that thang! |
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What are some matrixectomy complications? Why?
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Infection/delayed healing/reoccurance
Strongly compliance related |
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Does everyone have to soak post op?
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Yes... I mean, no.
could simply apply topical antibiotics and/or corticosteroids Can use antibacterial gels also |
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What are two reasons for issue reocurrance after nail procedure?
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Chemical/other are ineffective
Insufficient nail was removed |
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what is the activity recommendation post Nail op?
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Activity as tolerated.
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What is routine recommendation for pain post nail-op?
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Acetominaphen or ibuprofen are adequate
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What are some matrixectomy complications? Why?
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Infection/delayed healing/reoccurance
Strongly compliance related |
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What are two reasons for issue reocurrance after nail procedure?
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Chemical/other are ineffective
Insufficient nail was removed |
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What are contraindications for Nail Surgeries?
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blood thinners/anticoagulants
Diabetics PAD Preggo PM vs Avulsion |
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How does insurance "see" the tx of nail infection surgeries?
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Not elective
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What are some indications for "sharp" nail surgery?
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Failed chemical/other
condition also requires tissue reduction (eg. Hypertrophic ungulabia) MUST BE INFECTION FREE! |
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What are the three Sharp procedures for nail reduction?
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Winograd
Frost Whitney Acisional |
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Explain Winograd Sx.
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Excision of matrix w/secondary purpose of debulking the excess tissue, use sutures that must be removed
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what is the Frost Technique?
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Same indications as winograd, uses sutures,
Cut nail plate, then cut L-shaped flap in eponychium, wedge incision to remove the offending nail plate, bed, matrix.Sutures to close |
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Winograd - ?? = Whitney Acisional?
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Essential a winograd without incising the eponychium,
no sutures |
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What are two procedures for a total nail matrixectomy?
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Zadik, Terminal Symes
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What is the zadik teqnique
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leave a proximal and distal flap to close the area where nail was removed.
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What is the terminal symes technique?
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No flaps like zadic, you just scrunch everything together and sew it up, toe looks considerably shorter.
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Procedure? Why do you think that?
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Terminal symes: just scruch everything together, toe becomes shortened.
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Procedure? How do you know that?
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Zadik: Has two flaps that are joined.
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Describe the Frost procedure
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What is this? What type of nail Sx?
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SUX: total avulsion (unless you don't need to post bone Sx)
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What are post op care instructions for Sharp Matrixectomies?
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No soaking, clean and dry, refrain from activity please, more painflu.
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What are sharp matrixectomy complications?
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Infection/Pain/ Reocurrence
all have a higher rate with sharp techniques, but still strongly compliance related. |
