Dermatology Online Journal

Versatile sterile field for nail surgery using a sterile glove
Jamie Lynn McGinness MD, Harry L Parlette III MD
Dermatology Online Journal 11 (3): 10

Department of Dermatology, University of Virginia. jlm6qe@virginia.edu

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Abstract

Nail surgery is frequently done by dermatologists. Post-operative complications of nail surgery include infection, bleeding, pain, pyogenic granuloma, and nail dystrophy. Infectious complications after nail surgery can be prevented with proper aseptic techniques. Standard fenestrated surgical drapes used for a sterile field during nail surgery are cumbersome and difficult to keep in place during surgery. We present a versatile sterile field for nail surgery using a sterile glove that will facilitate nail surgery and concomitantly decrease the risk of infection.

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Introduction

Nail surgery is an important part of dermatologic surgery. The procedures performed on the nail unit by the dermatological surgeon include matricectomy, matrix and nail bed biopsies, nail avulsion, excisions, and nail fold biopsies [1, 2, 3].

Complications are possible with any surgical procedure. The dermatologic surgeon who decides to perform nail surgery must use careful patient selection to help eliminate some of the surgical complications [1]. Patients who are at particular risk of surgical complications following nail surgery include those with diabetes mellitus, peripheral vascular disease, or connective tissue disease [3].

Post-operative complications of nail surgery include infection, bleeding, pain, injury to vessels and nerves, nail deformity, and pyogenic granuloma [1]. Infection is an important consideration with nail surgery, especially toenail surgery. Post-operative infectious complications from nail surgery include superficial infections, acute purulent tenosynovitis, septic arthritis, and osteomyelitis [4]. The feet commonly harbor organisms including Gram-positive and Gram-negative bacteria and fungi. These organisms can lead to increased morbidity post-operatively from infectious complications.

It is important to use antiseptic preparation before any surgical procedure is performed on the nail apparatus. It is also important to have a sterile surgical field that allows adequate visualization of the nail, but prevents contamination from the surrounding area. Harrington et al [5] described a sterile glove and hemostat being used as a tourniquet and commented on the infection control with this technique. We describe below a simple method to create a sterile surgical field while performing nail surgery on fingers or toes.

Procedure

Figure 1	Figure 2
Figure 1: Sterile glove being used as a sterile surgical field for nail surgery. The glove fits snugly on the hand. The tip of the glove finger is removed on the digit that is to be operated on.
Figure 2: The glove finger is rolled back on the digit of the finger to be operated on. This technique will give some hemostasis.

Figure 3
Figure 3: A snugly fitting sterile glove being used as a sterile drape for toenail surgery. The glove finger of the nail to be operated on is rolled toward the proximal digit and will provide some hemostasis.

The first step when performing nail surgery is to use an antiseptic preparation, such as chlorhexidine gluconate, to cleanse the operative area and the surrounding areas of the hand or foot. Next, a sterile field should be set up. This is often accomplished in a conventional manner by using a fenestrated drape. However, a fenestrated drape can be cumbersome and difficult to keep in place during the procedure. An alternative would be to use a sterile glove. The glove should be sized to fit snugly around the hand or distal foot. If this technique is used for nail surgery on the hand, the tip of the glove finger of the digit to be operated on is removed. The glove finger of the digit to be operated on should be rolled back towards the proximal part of the digit. This will not only allow visualization of the nail unit, but can also be used to assist with hemostasis [6]. A sterile drape is now in place and the surgery is ready to be performed.

Conclusion

Surgical complications following nail surgery are infrequent, especially when proper precautions are taken. The most common complications include infection, bleeding, pain, and nail dystrophy. We presented a simple and easy method to help prevent post-surgical infectious complications. This method creates not only a sterile field, but provides the surgeon a compact and stable surgical field. This technique can be used for nail surgeries of the hand or foot.

References

1. Moossavi M, Scher RK. Complications of nail surgery: a review of the literature. Dermatol Surg. 2001 Mar;27(3):225-8. PubMed

2. de Berker DA, Dahl MG, Comaish JS, Lawrence CM. Nail surgery: an assessment of indications and outcome. Acta Derm Venereol. 1996 Nov;76(6):484-7. PubMed

3. Scher RK. Nail surgery. Clin Dermatol. 1987 Oct-Dec;5(4):135-42. PubMed

4. Ashbell TS, Kleinert HE, Putcha SM, Kutz JE. The deformed finger nail, a frequent result of failure to repair nail bed injuries. J Trauma. 1967 Mar;7(2):177-90. PubMed

5. Harrington AC, Cheyney JM, Kinsley-Scott T, Willard RJ. A novel digital tourniquet using a sterile glove and hemostat. Dermatol Surg. 2004 Jul;30(7):1065-7. PubMed

6. Shaw JA, DeMuth WW, Gillespy AW. Guidelines for the use of digital tourniquets based on physiological pressure measurements. J Bone Joint Surg Am. 1985 Sep;67(7):1086-90. PubMed

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