1
Q
anonychia
A
absence of nail; usually congenital
2
Q
beau’s lines
A
transverse lines in nail plate due to trauma, disease, meds (cancer pts, methotrexate use, malnutrition, etc)
3
Q
nail clubbing
A
- increased longitudinal and transverse curvature of nails
- associated w/ IBD, heart disease, cirrhosis, CPD, lung malignancy, bacterial endocarditis
4
Q
hypertrophic osteodystrophy
A
subperiosteal formation of new cancellous bone at distal ends of DPs
- associated w/ clubbing, bronchogenic carcinoma
5
Q
splinter hemorrhages
A
- thin, red-brown longitudinal lines
- associated w/ subacute bacterial endocarditis, trauma, vitamin C deficiency
6
Q
subungual hematoma
A
- bleeding under nail
- need to differentiate from melanoma: hematoma will grow out
- should obtain radiographs for possible DP Fx
- if <25% nail plate is involved, evacuate blood; if >25% of nail plate is involved, nail avulsion
7
Q
koilonychia
A
- soft spoon-shaped nails
- associated w/ iron-deficient anemia
8
Q
onychauxis
A
- thickened nails
- associated w/ local or systemic disease
9
Q
onychocryptosis
A
ingrown toenail
10
Q
onycholysis
A
separation of nail plate from nail bed
11
Q
onychogryphosis
A
thick ram-horn nails
12
Q
onychomycosis: distal subungual
A
common, usually t. rubrum
13
Q
onychomycosis: proximal subungual
A
rarest; usually t. rubrum
14
Q
onychomycosis: superficial white
A
common, t. mentagrophytes
15
Q
subungual exostosis
A
- bony growth at distal phalanx
- can lead to pincer nail, onychocryptosis
- can be 2° to trauma (ie fx that never healed)
16
Q
lovibond angle
A
angle between nail plate and proximal nail fold
<165° is normal ; >180° is clubbing
17
Q
schamroth sign
A
for nail clubbing
18
Q
periungual verruca
A
- benign fibroepithelial growth w/ rough HPK surface; caused by HPV
19
Q
pyogenic granuloma *
A
- hypertrophic vascular tissue 2° to trauma or infection
- can treat w/ retinoids, anti-retrovirals, can cauterize w/ silver nitrate
19
Q
periungual fibroma
A
- rare lesion of proximal nail fold
- can be a marker of tuberous sclerosis complex
20
Q
myxoid cyst
A
- smooth flesh-colored nodule w/ gelatinous fluid
- usually at dorsal dermis by DIPJ, prox nail fold
- can impinge nail matrix
- best treatment is joint cleaning + fusion
21
Q
glomus tumor
A
- small, intense, pulsating spontaneous lesion beneath nail
22
Q
squamous cell carcinoma
A
- most common, low-grade malignancy
- need to excise
23
Q
malignant melanoma
A
- usually asymptomatic
- malignant proliferation of melanocytes
- hutchinson’s sign +: spread to surrounding skin
24
melanocyte activation vs nevus
- melanocyte activation: increased pigment production w/o melanocyte proliferation
- nevus: benign proliferation
25
paronychia
- bacterial infection of surrounding soft tissue of nail
- usually staph, 2° is candida, pseudomonas
- males 3:1
- malodorous, abundant granulation tissue
- exudate may occlude drainage: results in abscess, seroma, hematoma
26
mozena classification system: use
for classifying onychocryptosis and determining treatment
27
mozena I
- mild erythema, edema, pain w/ pressure applied to lateral fold
Hallmark: local irritation w/ no drainage
- conservative treatment: can use slant back
28
mozena IIa
- increased stage I symptoms, drainage + infection
- nail fold < 3 mm
- conservative treatment and/or matrixectomy w/ hypertrophic ungual labial fold reduction
29
mozena IIb
- same as IIa, but nail fold is ≥ 3 mm
30
mozena III
- presence of granulation tissue, nail fold hypertrophy
- matrixectomy w/ excision of hypertrophic ungual labial fold
31
local anesthetic for nail avulsion
2 point block w/ 3-5 mL anesthesia
32
nail avulsion: steps
1. local anesthesia: 2 pt block
2. prep w/ betadine, tourniquet if desired
3. use spatula for blunt dissection at lateral + proximal nail folds to separate nail plate from nail bed
4. cut back proximally w/ english anvil
5. rotate freed nail medially + off w/ hemostat
6. irrigate + apply sterile dressing
33
phenol-alcohol matrixectomy: requirements
need a bloodless field
34
chemical matrixectomy: options
- phenol-alcohol (most common): 89% phenol 3 x 30 sec. irrigate w/ alcohol to flush phenol
- NaOH: 10% NaOH for 3 sec - 3 min. flush w/ acetate to neutralize
35
winograd procedure: steps
1. make first longitudinal incision through nail/bed; second through skin at nail fold (semicircle)
2. wedge of tissue is removed down to periosteum
3. curette, close w/ sutures
36
frost procedure: steps
1. inverted L incision through long axis of nail to periosteum
2. skin flap freed from matrix
3. nail matrix removed w/ curette
4. suture closed
37
zadik procedure: steps
1. create 2 lateral incisions and one horizontal incision to expose the nail matrix
2. excise matrix
3. suture closed
38
suppan procedure: steps
1. place 15 blade under eponychium
2. draw blade medially to laterally over matrix to resect
no sutures needed
39
kaplan procedure: indications
subungual exostosis
40
kaplan procedure: steps
1. create 2 proximal incisions and 1 distal incision
2. remove entire nail bed and matrix from distal phalanx
3. heal 2° intention
41
terminal syme: indications
subungual osteoma, glomus tumor, mallet toe, macrodactyly, osteomyelitis
42
terminal syme procedure: steps
1. total nail avulsion + matrix excision
2. removal of distal 1/3 of distal phalanx
3. closure by plantar skin flap
43
rosenthal classification system: use
classifying zones of nail bed tissue loss
44
rosenthal classification: zone 1
- distal to bony phalanx
- treat w/ irrigation, debridement, allow for granulation. may need a graft if wound is >1cm
45
rosenthal classification: zone 2
- distal to lunula, distal phalanx exposed
- treat w/ irrigation and debridement, possible flap closure
46
rosenthal classification: zone 3
- proximal to distal end of lunula; minimal nail bed survival
- treat w/ OR debridement, nail plate excision, terminal syme
47
V-Y plasty: steps
1. digital block, exsanguination, tourniquet
2. debride non-viable tissue, including bone if exposed
3. create triangular-shaped flap w/ base at cut edge of skin where amputation occurred
4. make full thickness incision w/o undermining flap
5. advance flap over defect, suture to nail bed
6. v-shaped defect converted to Y-shaped wound
48
1° onycholysis
separation of nail plate from nail bed; can be traumatic avulsion or from microtrauma
Gen Surg
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