- Discussion:
- consider photographs for documentation;
- consent should explain possibility of long term nail disfigurement;
- instruments:
- freer septum elevator, dental spatulas, fine hemostats, beaver
blade, small currette, single and double pronged skin hooks;
- an easy way of applying a tourniquet is to prep the patient's hand and then
to apply a sterile surgeon glove;
- cut the tip of the glove of the involved finger and roll the gloove tip
proximally until it reaches the proximal phalanx, thus creating a
digital tourniquet, as well as protecting the wound from what is often
a dirty hand;
- alteratively, make a tournequet using Penrose Drain and mosquito clamp;
- 3/8 inch Penrose Drain is placed at distal end of digit, leaving
and exposed "tail."
- the drain is then wrapped proximally to the proximal edge of the
digit, and is then secured with a hemostat;
- the distal tail is then unwound;
- suture: 5-0 and 6-0 chromic gut for nail bed;
5-0 prolene for nail fold;
-
anesthesia:
- never use anesthetics containing epinephrine in the digits;
- avoid injecting excessive amounts of anesthetic into the digit
as this may cause ischemia;
- distal wing block:
- needs to be supplemented w/ more proximal metacarpal block;
- injection site: just proximal to the edges of the lateral
nail folds;
- use no more than 1 cc of anesthetic on each side of digit;
