Reference no: EM133432786
Question: The patient is a 60-year-old female who has a persistently in growing great toenail on the left foot that has had two past infections. The infection is now clear, and the patient presents for wedge resection of the toenail. She also has pernicious anemia. Friedreich's ataxia, and heart disease. Because of these conditions a digital block will be used for the procedure. Procedure: wedge resection of toenail
Procedure Description: The patient is placed int the supine position, with the knees flexed, and the left food is flat on the table. The toe is prepped and cleansed. A standard digit block is performed with 1 percent lidocaine using a 10-ml syringe and a 30-guage needle. Approximately 3 ml is instilled on each side of the toe.
After waiting 10 minutes, a sterilized rubber band is placed around the base of the toe. The toe is resterilized and draped with the toe protruding. A nail elevator is slid under the cuticle to separate the nail plate from the overlying proximal nail fold. The lateral one fourth of the nail plate is identified as the site for the partial lateral nail removal. A bandage scissors is used to cut from the distal end of the straight back beneath the proximal nailfold. A straight, smooth, new lateral edge to the nail plate is created. The lateral piece of nail is grasped with a hemostat and removed in one piece, pulling straight out.
Electrocautery ablation is used to destroy the nail matrix where the nail was removed. The matrix is treated twice. Antibiotic ointment is applied, and a bulky gauze dressing is placed. The food is placed in a surgical boot. Post-op instructions are given for daily cleansing with warm water, and strenuous exercise is to be avoided completely for at least one week. The patient tolerated the procedure well and understands the discharge instructions.
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