Mitos en Cirugia de Uñas

Published in Dermatology

Journal Scan / Review · February 27, 2020

Nail Surgery Myths and Truths

Journal of Drugs in Dermatology

TAKE-HOME MESSAGE

• In an effort to address common barriers dermatologists experience with nail surgery, these authors review and analyze the current literature as it pertains to five common myths relevant to nail surgery.

• There are sufficient data to conclude that epinephrine is safe to use in digital procedures, although it is often not necessary, particularly when using a tourniquet. Hydrogen peroxide has been shown to have a beneficial role in wound healing in several trials, contrary to popular beliefs that it may impair wound healing. Cleansing postoperative wounds with tap water will not increase infection rates compared with rinsing with sterile saline. Postsurgical prophylactic topical antibiotics for clean wounds may lead to allergic contact dermatitis, impair healing, and increase antibiotic resistance; they do not decrease infection rates and thus should be avoided. Digital dressings have a low-risk profile when applied with proper technique, and calcium alginate or acellular amniotic membrane dressings should be considered.

– Caroline K. Crabtree, MD

Written by

 

 

Nathaniel J. Jellinek MD, FAAD, FACMS

The nail unit remains an underappreciated appendage in dermatology, and nail surgery, in particular, is eschewed by many. Why is this so, why is this avoidance an important phenomenon, and what can be done to reverse this trend?

As the authors note in their introduction, there is a legacy of a lack of exposure to nail surgery that tends to self-perpetuate. Unfortunately, for dermatologists who are dedicated to diseases of the skin, hair, and nails, any discomfort or lack of confidence with nails acts as a disservice to our patients. And it is only through intentional training and exposure that we can change the culture and narrow the practice gap. To this end, the American Academy of Dermatology and American College of Mohs Surgery have established "hands-on" half-day courses dedicated to this topic. These are unique opportunities to learn and practice the requisite skills with expert supervision.

Competent nail surgery can be broken down into a few key areas, mastery of which allows seamless surgical execution. These are complete anesthesia, a bloodless field, adequate surgical exposure, hemostasis, and postoperative analgesia/wound care. As the authors note, there are myths surrounding many of these topics, and it behooves all of us to stay up to date with current information. Indeed, although myths are not necessarily lies, they share some of the same insidious traits—once disseminated, it takes an inordinate amount of time, effort, and study to change opinions that have been misled. One needs to look no further than the fallacious link between vaccines and autism to see these consequences. As is pointed out, most of the myths have been passed down as conventional wisdom rather than data-driven truths. It is not only important to perform studies testing these teachings, but, even more so, to summarize those data and disseminate this information to our colleagues.

Abstract

INTRODUCTION

There is a paucity of randomized trials on nail surgery. Since there are no established guidelines, dermatologists may have false beliefs about best practices in performing nail surgery and post-procedural care.

METHODS

We identified five common myths concerning nail surgery. A PubMed search was performed to refute or support these beliefs.

RESULTS

We found compelling evidence that refutes these nail surgery myths. We found that epinephrine can be safely used for nail surgery, hydrogen peroxide and tap water is recommended for wound cleansing, prophylactic topical antibiotics should be avoided, calcium alginate, or amniotic membrane dressings are valuable dressing alternatives, and digital dressings have a low risk profile with precise technique.

DISCUSSION

Randomized controlled trials for nail surgery are lacking. Data from similar fields may guide dermatologists in performing nail surgery.

Journal of Drugs in Dermatology

Nail Surgery Myths and Truths

J Drugs Dermatol 2020 Mar 01;19(3)xx, JW Ricardo, SR Lipner 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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