04/07/2015 Ben Summerhays DPM Assistant Clinical Professor Department of Orthopaedics 1 04/07/2015    1. Infected 2. Painful nail: non-infected 3. Non-permanent vs. Permanent  HISTORY  Duration  Past treatments  Frequency  Medications  PMH 2 04/07/2015  Physical Exam       Vascular Palpation Drainage Nail borders Type of Nail Type of Treatment      Slant Back Partial avulsion Total avulsion This is the partial nail Avulsion I would do if only one side is infected or if a permanent procedure is needed I would then sneak my chemical on a Q-tip under the proximal nail fold 3 04/07/2015    Partial Nail avulsion On the left just after removal, on right healed nail after avulsion Total nail avulsion-nasty nail total removal needed 4 04/07/2015  Supplies         1% lidocaine plain 5-10 ccs usually Chloraprep-usually use this Rubber band tourniquet-I only use if chemical used Curette or freer-to free nail from surrounding skin English anvil Beaver handle and blade Hemostat-straight Digital Block      5cc syringe H-block or V-block digital block 1.5 inch 27 gauge needle V block for toes 2-5 H block is for big toe 5 04/07/2015  H-block  V-block 6 04/07/2015  Paint toe with betadine or chloraprep Sterile equipment Not sterile procedure  English Anvil   7 04/07/2015     Beaver handle and 64 blade Nail removal-Straight hemostat Hand Rotation-rotate toward the center Residual Nail-check for after removal 8 04/07/2015  Hemostasis     Release tourniquet Manual Pressure Silver nitrate Dressings     Triple antibiotic ointment x1 4X4 gauze Coban Cut Band-Aid 9 04/07/2015 10 04/07/2015 11 04/07/2015 12 04/07/2015  Chemical Matrixectomy:     89% phenol chemical 10% sodium hydroxide ~90% successful Redness 2-6 weeks 13 04/07/2015  Extremely Rare to be given if nail removed  Aftercare  Dressing change-next morning  For just infected ones abx oint, and bandaid     Soaking-Warm H20 with Epsom 20 min X2-3 per day Activity-as tolerated POD #1 Pain medication-never Follow-up  Global period-10 days  PRN 14 04/07/2015 15