The document discusses the causes, symptoms, diagnosis and treatment of ingrown toenails. It begins by defining ingrown toenails as a common condition where the nail edge grows into the skin, causing pain. Risk factors include poorly fitting shoes and improperly trimmed nails. Symptoms progress from pain to infection if left untreated. Diagnosis is usually clinical. Treatment ranges from conservative approaches like soaking the toe and splinting the nail, to surgical techniques like partial nail removal or chemical ablation of the nail matrix. The goal of treatment is to relieve symptoms and prevent recurrence.
Common causes of ingrown toenails include wearing shoes that are too tight, cutting toenails too short or not straight across, and toe injuries. To prevent ingrown toenails, toenails should be trimmed straight across with no rounded corners and extend past the skin, and shoes and socks should fit properly and feet should be kept clean. An ingrown toenail grows into the skin at the nail borders, causing pain, redness, and possible infection if the skin is broken.
This document provides tips and instructions for using a PowerPoint presentation on lower limb ulceration. It discusses actively engaging students by showing blank slides first to elicit what they know before providing information. Treatment of lower limb ulcers focuses on compression therapy, wound care, infection control and improving circulation and nutrition. Surgical options are available for advanced cases that do not heal with compression, including procedures to remove veins and treat varicose veins. Lifelong compression therapy is important after healing to prevent recurrence.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
A varicose ulcer is a painful lesion that develops on the skin of the legs when underlying veins are unable to efficiently pump blood due to malfunctioning venous valves. This causes blood to pool in the legs. Risk factors include immobility, obesity, varicose veins, and age. Treatment involves cleaning and dressing the wound along with compression bandages to control blood pressure in the legs. Larger ulcers may take longer to heal but 70% of small ulcers will heal within 12 weeks of starting treatment.
This document provides information on chronic leg ulcers, including their definition, causes, clinical presentation, diagnosis, and management. It defines an ulcer as a loss of epithelial continuity that does not heal or recurs. The most common causes of chronic leg ulcers are venous insufficiency, arterial insufficiency, and neuropathy. Clinical assessment involves examining the ulcer's location, edges, base, and surrounding skin/tissue. Diagnosis is aided by medical history, physical exam, and tests like Doppler ultrasound and ankle-brachial index. Treatment involves addressing the underlying cause, wound care, dressings, compression therapy, and sometimes surgery.
- The document classifies open fractures using the Gustilo-Anderson classification system based on wound size, soft tissue injury, and degree of contamination. Grade I fractures have a clean wound less than 1 cm, while Grade III fractures have extensive soft tissue damage or injury over 8 hours old.
- Management of open fractures aims to prevent infection through prompt debridement, antibiotics, splinting, and wound coverage. Early debridement within 5 hours can significantly reduce infection rates compared to later debridement.
- Risk of infection increases with higher fracture grade, from 0-12% for Grade I up to 9-55% for Grade III fractures. Prompt antibiotics, debridement, and wound management seek
Ganglion cysts are small, mucus-filled cysts that commonly occur on the back of the wrist. They can also develop on other joints like fingers, knees, and ankles. Ganglion cysts are usually painless bumps but can become painful with activity. Ultrasound or MRI can confirm the cystic nature of the bump. Treatment involves initial aspiration and steroid injection for small cysts. Larger or recurring cysts may require surgical excision to prevent reoccurrence.
This document discusses different types of leg ulcers including venous, arterial, diabetic neuropathic, and hypertensive ulcers. It provides information on:
1. The causes, risk factors, signs and symptoms, investigations and management for each type of ulcer.
2. Venous ulcers are the most common type, caused by venous insufficiency and reflux, and are typically treated with compression therapy and dressings.
3. Arterial ulcers are caused by peripheral arterial disease and present with dry necrotic wounds, often over bony prominences of the feet. Revascularization may be required for healing.
4. Diabetic and neuropathic ulcers occur due to loss of sensation from
Common causes of ingrown toenails include wearing shoes that are too tight, cutting toenails too short or not straight across, and toe injuries. To prevent ingrown toenails, toenails should be trimmed straight across with no rounded corners and extend past the skin, and shoes and socks should fit properly and feet should be kept clean. An ingrown toenail grows into the skin at the nail borders, causing pain, redness, and possible infection if the skin is broken.
This document provides tips and instructions for using a PowerPoint presentation on lower limb ulceration. It discusses actively engaging students by showing blank slides first to elicit what they know before providing information. Treatment of lower limb ulcers focuses on compression therapy, wound care, infection control and improving circulation and nutrition. Surgical options are available for advanced cases that do not heal with compression, including procedures to remove veins and treat varicose veins. Lifelong compression therapy is important after healing to prevent recurrence.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
A varicose ulcer is a painful lesion that develops on the skin of the legs when underlying veins are unable to efficiently pump blood due to malfunctioning venous valves. This causes blood to pool in the legs. Risk factors include immobility, obesity, varicose veins, and age. Treatment involves cleaning and dressing the wound along with compression bandages to control blood pressure in the legs. Larger ulcers may take longer to heal but 70% of small ulcers will heal within 12 weeks of starting treatment.
This document provides information on chronic leg ulcers, including their definition, causes, clinical presentation, diagnosis, and management. It defines an ulcer as a loss of epithelial continuity that does not heal or recurs. The most common causes of chronic leg ulcers are venous insufficiency, arterial insufficiency, and neuropathy. Clinical assessment involves examining the ulcer's location, edges, base, and surrounding skin/tissue. Diagnosis is aided by medical history, physical exam, and tests like Doppler ultrasound and ankle-brachial index. Treatment involves addressing the underlying cause, wound care, dressings, compression therapy, and sometimes surgery.
- The document classifies open fractures using the Gustilo-Anderson classification system based on wound size, soft tissue injury, and degree of contamination. Grade I fractures have a clean wound less than 1 cm, while Grade III fractures have extensive soft tissue damage or injury over 8 hours old.
- Management of open fractures aims to prevent infection through prompt debridement, antibiotics, splinting, and wound coverage. Early debridement within 5 hours can significantly reduce infection rates compared to later debridement.
- Risk of infection increases with higher fracture grade, from 0-12% for Grade I up to 9-55% for Grade III fractures. Prompt antibiotics, debridement, and wound management seek
Ganglion cysts are small, mucus-filled cysts that commonly occur on the back of the wrist. They can also develop on other joints like fingers, knees, and ankles. Ganglion cysts are usually painless bumps but can become painful with activity. Ultrasound or MRI can confirm the cystic nature of the bump. Treatment involves initial aspiration and steroid injection for small cysts. Larger or recurring cysts may require surgical excision to prevent reoccurrence.
This document discusses different types of leg ulcers including venous, arterial, diabetic neuropathic, and hypertensive ulcers. It provides information on:
1. The causes, risk factors, signs and symptoms, investigations and management for each type of ulcer.
2. Venous ulcers are the most common type, caused by venous insufficiency and reflux, and are typically treated with compression therapy and dressings.
3. Arterial ulcers are caused by peripheral arterial disease and present with dry necrotic wounds, often over bony prominences of the feet. Revascularization may be required for healing.
4. Diabetic and neuropathic ulcers occur due to loss of sensation from
This document discusses diabetic foot ulcers. It defines a diabetic foot ulcer and lists risk factors such as neuropathy and peripheral vascular disease. It describes the etiology involving neuropathy, angiopathy, and infection. Clinical presentation includes examination of the ulcer, skin, pulses, and neurological assessment. Classification systems like Wagner's are mentioned. Workup involves biochemical testing, imaging, and assessment of vascular and neurological function. Management discusses wound care, offloading pressure, infection treatment, and surgical interventions.
DIABETIC FOOT ULCER- / SURGICAL WOUNDS
#surgicaleducator #diabeticfootulcer #surgicaltutor #babysurgeon #usmle
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today in this episode I have discussed Diabetic Foot Ulcer- DFU
• It is a complication of Type 2 Diabetes
• I have discussed about the overview, epidemiology, etiopathogenesis, clinical features, assessment, investigations, grading and treatment of Diabetic Foot Ulcer- DFU
• I hope this video is interesting and also useful to all of you
• You can watch the video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
Crush syndrome is caused by prolonged pressure on muscle tissue, leading to rhabdomyolysis. It causes systemic effects like kidney failure due to the release of toxins from damaged muscle into the bloodstream. Signs include dark urine, fever, arrhythmias and respiratory failure. Treatment involves aggressive fluid resuscitation, dialysis, antibiotics, surgical debridement of damaged tissue, and fasciotomy to release pressure in compartments. Early fluid resuscitation within 6 hours is key to preventing kidney damage from crush syndrome.
Lymphoedema is an abnormal swelling of limb due to the collection of excessive amount of high protein fluid secondary to defective lymphatic drainage in the presence of normal capillary filteration.It is very disabiling condition to the patient. In this ppp I have discussed its clinical picture and management in a simple way
Pyoderma gangrenosum is an uncommon inflammatory skin condition of unknown cause characterized by sterile pustules that form ulcers with necrotic margins. It typically affects adults ages 20-50 and presents as painful lesions that can develop rapidly. While the pathophysiology is poorly understood, it involves dysregulation of the immune system and neutrophils. Treatment involves immunosuppressants like corticosteroids and cyclosporine. Proper diagnosis requires ruling out infection and avoiding biopsy or surgery, as trauma can worsen lesions.
This document discusses keloids, which are non-cancerous growths that form scar tissue beyond the boundaries of the original skin injury or wound. Keloids most commonly affect individuals with darker skin and tend to run in families. While the exact causes are unknown, keloids result from an overactive inflammatory response and abnormal collagen deposition during wound healing. Common symptoms include pain, itching, and restriction of motion, as well as cosmetic concerns. Treatment involves surgical excision followed by radiation therapy within 72 hours, as this combination has shown success with a low recurrence rate. The Oncology and Cancer Center at Nairobi Hospital administers keloid treatment using radiation doses measured in Grays over one to three sessions, starting
This document discusses necrotizing fasciitis and gas gangrene. It defines necrotizing fasciitis as a necrotizing soft tissue infection along fascial planes that can present with disproportionate pain and swelling. Risk factors include diabetes and immunosuppression. Treatment involves broad-spectrum antibiotics and urgent debridement. Gas gangrene is caused by Clostridium bacteria, often after trauma. It presents with pain, swelling and crepitus, and is treated with antibiotics and radical debridement to remove necrotic muscle. Imaging may show gas in tissues. Both conditions require prompt recognition and aggressive treatment to prevent mortality.
Tennis elbow, also known as lateral epicondylitis, is a tendinopathy of the common extensor tendon near the lateral epicondyle of the elbow. It results from repetitive microtears in the tendon due to overuse from activities involving forceful wrist extension. Clinically, it presents as lateral elbow pain that worsens with activities like handshaking or turning a doorknob. Physical examination reveals tenderness over the lateral epicondyle. While most cases resolve with conservative treatment like rest, NSAIDs, bracing, and physical therapy within 6-12 months, surgical debridement may be considered for persistent or recurrent cases.
The document discusses compartment syndrome, which occurs when increased pressure within a confined body space, such as the leg or forearm, leads to ischemia and potential tissue death without intervention. It defines compartment syndrome and outlines its epidemiology, causes, clinical presentation, diagnosis via compartment pressure measurement, and management through fasciotomy to decompress the pressure and prevent limb loss or death. Early diagnosis and treatment within 6-12 hours of injury results in the best prognosis and recovery.
Dr. Ankur Mittal's presentation discusses stenosing tenosynovitis, also known as trigger finger. The anatomy of the flexor tendon sheath and pulley system is described. Trigger finger occurs when a thickened flexor tendon catches on the A1 pulley, most commonly in the ring finger. Conservative treatments include splinting, steroid injections, and exercises, while surgery involves open or percutaneous release of the A1 pulley. Postoperative care focuses on early mobilization while avoiding complications like nerve damage or bowstringing. Surgical synovectomy may be required in rheumatoid patients to address underlying synovitis.
Venous ulcer is one of the commonest complication of varicose veins. It may also occur in a condition called post phlebitic limb which is a sequelae to acute deep vein thronbosis. Hurry in surgical treatment of this condition before the ulcer heals could lead to a failure. Good conservative treatment for healing of the ulcer followed by surgical intervention gives the best results.
A Baker's cyst, also known as a popliteal cyst, is a fluid-filled bulge behind the knee caused by an escape of synovial fluid from the knee joint. It is most common in children aged 4-7 and adults aged 35-70. A primary cyst develops spontaneously while a secondary cyst is usually caused by an underlying knee problem like arthritis. Symptoms may include swelling, pain, and tightness behind the knee. Ultrasound and MRI scans can confirm the diagnosis. Treatment focuses on addressing the underlying knee issue through rest, ice, compression, elevation, physiotherapy, injections, or occasionally surgery.
This document provides an overview of Monteggia fracture dislocations, beginning with definitions, history, epidemiology, classification, mechanisms of injury, clinical features, management, complications, and recent updates. Monteggia fractures, first described in 1814, constitute 1-2% of forearm fractures. Bado's 1958 classification divides them into four types based on the direction of radial head dislocation and location of the ulna fracture. Type I is the most common, involving anterior radial head dislocation and ulna fracture. Nonoperative treatment typically involves closed reduction and casting, while surgery is indicated for failed reductions. Complications can include nerve injuries, ossification, and compartment syndrome.
Diabetic foot complications are a major cause of lower limb amputations. Factors like neuropathy, vasculopathy and immune dysfunction contribute to foot ulceration and infection in diabetes. Ulcers are classified based on etiology and severity. Management involves metabolic control, wound care, offloading, antibiotics, vascular assessment and revascularization if needed. Long term prevention relies on regular foot screening, education on foot care, appropriate footwear and multidisciplinary team approach.
Apply gentle pressure proximally
Surgeon: Check distal pulses and capillary refill
If no improvement:
Consider temporary arteriotomy or venous shunt
Delay closure and observe
Flap or graft may be needed
NECROTISING SOFT TISSUE INFECTION- Dr. Kiran Kumar G.apollobgslibrary
This document discusses necrotizing soft tissue infections (NSTI), which are characterized by rapidly progressive necrosis of subcutaneous tissue, fascia, or muscle. NSTIs are classified as fasciitis or myositis based on the affected tissue layer. The document outlines the differences between NSTI, cellulitis, and abscesses. It describes the types, presentations, risk factors, investigations, scoring systems, and treatment approaches for NSTI. Early and aggressive surgical debridement combined with broad-spectrum antibiotics is critical to reduce mortality from these severe infections.
Dupuytren’s contracture is a disease which causes the abnormal thickening of the tissue just beneath the skin of the hand. The thickening of tissue begins in the palm and can spread up to the fingers.
Mahashin akond presented on Colles' fracture, which is a break in the distal part of the radius bone 2.5cm above the articular surface. Colles' fractures most commonly occur in young adults and those over 40 years old from falls or direct blows. Treatment involves reduction, immobilization with a plaster cast or surgery, followed by physiotherapy to regain range of motion, strength, and function. Complications can include malunion, tendon rupture, osteoporosis, and delayed healing, though most fractures heal within 6-8 weeks with proper treatment and rehabilitation.
Combination therapy for recurrent ingrown toe nailKETAN VAGHOLKAR
ABSTRACT
Ingrown toe nail is one of the commonest foot lesion affecting young individuals. The recurrence rate with a variety of treatment modalities continues to be quite significant. Hence the need to develop a comprehensive combination therapy to reduce the recurrence rate. Onychocryptosis or ingrown toe nail is a common and painful form of nail disease. It affects adolescents and young males very commonly. A combination therapy comprising of wedge resection of the nail, matricectomy, phenol cauterization and wedge excision of hyper granulations for recurrent advanced presentation of ingrown toe nail is presented. A 32-year-old male with a history of recurrent ingrown toe nail, operated twice previously presented with an advanced stage of ingrown toe nail. Hypertrophic granulation tissue covered both lateral and medial nail plates. The patient was treated with an integrated surgical approach comprising of wedge resection of medial as well as lateral border of nail ensuring removal of spicules on either side, followed by wedge resection of underlying nail bed. This was followed by phenol cauterization and elliptical excision of hypertrophic granulations. The predisposing factors, natural history and treatment modalities are discussed. Combination therapy is a safe and the best option for recurrent ingrown toe nail. It can also be used as a form of primary treatment in fresh cases to prevent recurrence.
Keywords: Ingrown toe nail treatment recurrence, Nail plates, Onychocryptosis
A fingertip injury is defined as any soft tissue, nail or bony injury distal to the dorsal and volar skin creases at the distal interphalangeal joint and insertions of long flexor and extensor tendons of a finger or thumb.
The fingertips are exposed to all aspects of daily living,
recreation and work and it is perhaps no surprise they
are the most commonly injured part of the hand
This document discusses diabetic foot ulcers. It defines a diabetic foot ulcer and lists risk factors such as neuropathy and peripheral vascular disease. It describes the etiology involving neuropathy, angiopathy, and infection. Clinical presentation includes examination of the ulcer, skin, pulses, and neurological assessment. Classification systems like Wagner's are mentioned. Workup involves biochemical testing, imaging, and assessment of vascular and neurological function. Management discusses wound care, offloading pressure, infection treatment, and surgical interventions.
DIABETIC FOOT ULCER- / SURGICAL WOUNDS
#surgicaleducator #diabeticfootulcer #surgicaltutor #babysurgeon #usmle
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today in this episode I have discussed Diabetic Foot Ulcer- DFU
• It is a complication of Type 2 Diabetes
• I have discussed about the overview, epidemiology, etiopathogenesis, clinical features, assessment, investigations, grading and treatment of Diabetic Foot Ulcer- DFU
• I hope this video is interesting and also useful to all of you
• You can watch the video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
Crush syndrome is caused by prolonged pressure on muscle tissue, leading to rhabdomyolysis. It causes systemic effects like kidney failure due to the release of toxins from damaged muscle into the bloodstream. Signs include dark urine, fever, arrhythmias and respiratory failure. Treatment involves aggressive fluid resuscitation, dialysis, antibiotics, surgical debridement of damaged tissue, and fasciotomy to release pressure in compartments. Early fluid resuscitation within 6 hours is key to preventing kidney damage from crush syndrome.
Lymphoedema is an abnormal swelling of limb due to the collection of excessive amount of high protein fluid secondary to defective lymphatic drainage in the presence of normal capillary filteration.It is very disabiling condition to the patient. In this ppp I have discussed its clinical picture and management in a simple way
Pyoderma gangrenosum is an uncommon inflammatory skin condition of unknown cause characterized by sterile pustules that form ulcers with necrotic margins. It typically affects adults ages 20-50 and presents as painful lesions that can develop rapidly. While the pathophysiology is poorly understood, it involves dysregulation of the immune system and neutrophils. Treatment involves immunosuppressants like corticosteroids and cyclosporine. Proper diagnosis requires ruling out infection and avoiding biopsy or surgery, as trauma can worsen lesions.
This document discusses keloids, which are non-cancerous growths that form scar tissue beyond the boundaries of the original skin injury or wound. Keloids most commonly affect individuals with darker skin and tend to run in families. While the exact causes are unknown, keloids result from an overactive inflammatory response and abnormal collagen deposition during wound healing. Common symptoms include pain, itching, and restriction of motion, as well as cosmetic concerns. Treatment involves surgical excision followed by radiation therapy within 72 hours, as this combination has shown success with a low recurrence rate. The Oncology and Cancer Center at Nairobi Hospital administers keloid treatment using radiation doses measured in Grays over one to three sessions, starting
This document discusses necrotizing fasciitis and gas gangrene. It defines necrotizing fasciitis as a necrotizing soft tissue infection along fascial planes that can present with disproportionate pain and swelling. Risk factors include diabetes and immunosuppression. Treatment involves broad-spectrum antibiotics and urgent debridement. Gas gangrene is caused by Clostridium bacteria, often after trauma. It presents with pain, swelling and crepitus, and is treated with antibiotics and radical debridement to remove necrotic muscle. Imaging may show gas in tissues. Both conditions require prompt recognition and aggressive treatment to prevent mortality.
Tennis elbow, also known as lateral epicondylitis, is a tendinopathy of the common extensor tendon near the lateral epicondyle of the elbow. It results from repetitive microtears in the tendon due to overuse from activities involving forceful wrist extension. Clinically, it presents as lateral elbow pain that worsens with activities like handshaking or turning a doorknob. Physical examination reveals tenderness over the lateral epicondyle. While most cases resolve with conservative treatment like rest, NSAIDs, bracing, and physical therapy within 6-12 months, surgical debridement may be considered for persistent or recurrent cases.
The document discusses compartment syndrome, which occurs when increased pressure within a confined body space, such as the leg or forearm, leads to ischemia and potential tissue death without intervention. It defines compartment syndrome and outlines its epidemiology, causes, clinical presentation, diagnosis via compartment pressure measurement, and management through fasciotomy to decompress the pressure and prevent limb loss or death. Early diagnosis and treatment within 6-12 hours of injury results in the best prognosis and recovery.
Dr. Ankur Mittal's presentation discusses stenosing tenosynovitis, also known as trigger finger. The anatomy of the flexor tendon sheath and pulley system is described. Trigger finger occurs when a thickened flexor tendon catches on the A1 pulley, most commonly in the ring finger. Conservative treatments include splinting, steroid injections, and exercises, while surgery involves open or percutaneous release of the A1 pulley. Postoperative care focuses on early mobilization while avoiding complications like nerve damage or bowstringing. Surgical synovectomy may be required in rheumatoid patients to address underlying synovitis.
Venous ulcer is one of the commonest complication of varicose veins. It may also occur in a condition called post phlebitic limb which is a sequelae to acute deep vein thronbosis. Hurry in surgical treatment of this condition before the ulcer heals could lead to a failure. Good conservative treatment for healing of the ulcer followed by surgical intervention gives the best results.
A Baker's cyst, also known as a popliteal cyst, is a fluid-filled bulge behind the knee caused by an escape of synovial fluid from the knee joint. It is most common in children aged 4-7 and adults aged 35-70. A primary cyst develops spontaneously while a secondary cyst is usually caused by an underlying knee problem like arthritis. Symptoms may include swelling, pain, and tightness behind the knee. Ultrasound and MRI scans can confirm the diagnosis. Treatment focuses on addressing the underlying knee issue through rest, ice, compression, elevation, physiotherapy, injections, or occasionally surgery.
This document provides an overview of Monteggia fracture dislocations, beginning with definitions, history, epidemiology, classification, mechanisms of injury, clinical features, management, complications, and recent updates. Monteggia fractures, first described in 1814, constitute 1-2% of forearm fractures. Bado's 1958 classification divides them into four types based on the direction of radial head dislocation and location of the ulna fracture. Type I is the most common, involving anterior radial head dislocation and ulna fracture. Nonoperative treatment typically involves closed reduction and casting, while surgery is indicated for failed reductions. Complications can include nerve injuries, ossification, and compartment syndrome.
Diabetic foot complications are a major cause of lower limb amputations. Factors like neuropathy, vasculopathy and immune dysfunction contribute to foot ulceration and infection in diabetes. Ulcers are classified based on etiology and severity. Management involves metabolic control, wound care, offloading, antibiotics, vascular assessment and revascularization if needed. Long term prevention relies on regular foot screening, education on foot care, appropriate footwear and multidisciplinary team approach.
Apply gentle pressure proximally
Surgeon: Check distal pulses and capillary refill
If no improvement:
Consider temporary arteriotomy or venous shunt
Delay closure and observe
Flap or graft may be needed
NECROTISING SOFT TISSUE INFECTION- Dr. Kiran Kumar G.apollobgslibrary
This document discusses necrotizing soft tissue infections (NSTI), which are characterized by rapidly progressive necrosis of subcutaneous tissue, fascia, or muscle. NSTIs are classified as fasciitis or myositis based on the affected tissue layer. The document outlines the differences between NSTI, cellulitis, and abscesses. It describes the types, presentations, risk factors, investigations, scoring systems, and treatment approaches for NSTI. Early and aggressive surgical debridement combined with broad-spectrum antibiotics is critical to reduce mortality from these severe infections.
Dupuytren’s contracture is a disease which causes the abnormal thickening of the tissue just beneath the skin of the hand. The thickening of tissue begins in the palm and can spread up to the fingers.
Mahashin akond presented on Colles' fracture, which is a break in the distal part of the radius bone 2.5cm above the articular surface. Colles' fractures most commonly occur in young adults and those over 40 years old from falls or direct blows. Treatment involves reduction, immobilization with a plaster cast or surgery, followed by physiotherapy to regain range of motion, strength, and function. Complications can include malunion, tendon rupture, osteoporosis, and delayed healing, though most fractures heal within 6-8 weeks with proper treatment and rehabilitation.
Combination therapy for recurrent ingrown toe nailKETAN VAGHOLKAR
ABSTRACT
Ingrown toe nail is one of the commonest foot lesion affecting young individuals. The recurrence rate with a variety of treatment modalities continues to be quite significant. Hence the need to develop a comprehensive combination therapy to reduce the recurrence rate. Onychocryptosis or ingrown toe nail is a common and painful form of nail disease. It affects adolescents and young males very commonly. A combination therapy comprising of wedge resection of the nail, matricectomy, phenol cauterization and wedge excision of hyper granulations for recurrent advanced presentation of ingrown toe nail is presented. A 32-year-old male with a history of recurrent ingrown toe nail, operated twice previously presented with an advanced stage of ingrown toe nail. Hypertrophic granulation tissue covered both lateral and medial nail plates. The patient was treated with an integrated surgical approach comprising of wedge resection of medial as well as lateral border of nail ensuring removal of spicules on either side, followed by wedge resection of underlying nail bed. This was followed by phenol cauterization and elliptical excision of hypertrophic granulations. The predisposing factors, natural history and treatment modalities are discussed. Combination therapy is a safe and the best option for recurrent ingrown toe nail. It can also be used as a form of primary treatment in fresh cases to prevent recurrence.
Keywords: Ingrown toe nail treatment recurrence, Nail plates, Onychocryptosis
A fingertip injury is defined as any soft tissue, nail or bony injury distal to the dorsal and volar skin creases at the distal interphalangeal joint and insertions of long flexor and extensor tendons of a finger or thumb.
The fingertips are exposed to all aspects of daily living,
recreation and work and it is perhaps no surprise they
are the most commonly injured part of the hand
This document discusses various flap techniques used in periodontal surgery. It defines flaps as sections of gingiva and mucosa surgically separated from underlying tissues to provide access to bone and roots. Full and partial thickness flaps are classified based on the depth of tissue reflection. Techniques include the modified Widman flap, undisplaced flap, apically displaced flap, papilla preservation flap, and techniques for distal molar surgery. Healing after flap surgery is described in stages from initial clot formation to establishment of new connective tissue attachment after 4 weeks.
Complications occur During Dental Extraction and their ManagementIraqi Dental Academy
This simplified lecture explain briefly the Complications occur During Dental Extraction and their Management.
It is presented to the level of mind of undergraduate students
A periodontal flap is a section of gingiva and/mucosa that is surgically separated from the underlying tissue to provide visibility and the access to the bone and the root surface. The flap also allows the gingiva to be displaced to a different location in patients with mucogingival involvement.
In this PowerPoint presentation, the periodontal flap is described under the headings: indication, contraindications, classification of flaps, flap design, horizontal and vertical incisions and various flap technique such as modified widman flap, undisplaced flap, palatal flap, apically displaced flap, papilla preservation flap and distal molar surgery for maxillary and mandibular molars. It also contains healing after flap surgery.
Gingivectomy is the surgical excision of gingiva to remove diseased pocket walls and expose tooth surfaces. It is indicated for conditions like suprabonny pockets, fibrous enlargement, and crown lengthening. There are several types of gingivectomy including surgical, chemosurgery, electrosurgery, cryosurgery, and laser gingivectomy. The surgical procedure involves marking pockets, making internal beveled incisions, removing diseased tissue and calculus, and placing a periodontal pack. Post-operative healing occurs through clot formation, granulation tissue growth, and epithelialization over 2-3 weeks.
Paronychia is an infection of the nail fold that presents with finger or toe pain, redness, and swelling. There are three types: chronic, acute, and subungual. Chronic paronychia is treated conservatively with antibiotics and soaks or more aggressively with nail/skin excision. Acute paronychia is drained with a needle or scalpel after separating the cuticle. Subungual abscesses are drained by removing part of the overlying nail. Proper treatment involves drainage and soaks, with antibiotics optionally for cellulitis. More extensive infections may require nail/skin excision for complete drainage.
This document discusses principles of incisions and flap design for minor oral surgery. It describes five basic principles of incisions, including using a sharp blade, making firm continuous strokes, avoiding cutting vital structures, holding the blade perpendicular to epithelial surfaces, and properly placing incisions. It also outlines various types of mucoperiosteal flaps like envelope, three-corner, four-corner, semilunar, Y-incision, and pedicle flaps. Complications of flap design like necrosis, dehiscence, tearing, and injury are addressed. Considerations for flap design include ensuring an adequate blood supply, avoiding tension, and not crossing bony prominences.
Local Complications in Dental Implants SurgeryNeil Pande
This document discusses early and late stage complications that can occur after dental implant surgery. Early stage complications within the immediate postoperative period include edema, exudate, pain, and infection caused by bacterial contamination during surgery. Late stage complications occur during osseointegration and include bone defects, periapical lesions, failed osseointegration, and mandibular fractures. Prevention of complications focuses on strict asepsis during surgery, atraumatic surgical techniques, appropriate treatment planning, and proper management of healing.
GINGIVAL SURGICAL TECHNIQUES IN PERIODONTOLOGYSupriya Bhat
This document provides an overview of different gingival surgical techniques including gingival curettage, gingivectomy, and gingivoplasty. It discusses the history, rationale, indications, contraindications, procedures, healing processes, and clinical appearances for each technique. Gingival curettage involves scraping the gingival pocket wall to remove diseased soft tissue, while gingivectomy is the excision of gingiva to eliminate supra bony pockets. Different techniques for performing these surgeries include using curettes, electrosurgery, lasers, or chemosurgery. Proper application of these techniques aims to reduce inflammation and promote new tissue attachment and bone regeneration.
This document discusses the anatomy and pathology of the maxillary sinus and oroantral communications. It describes the location and drainage of the maxillary sinus and causes of sinusitis. Oroantral communications are defined as pathological connections between the oral cavity and maxillary sinus that can form due to dental procedures or trauma. Signs, testing methods, prevention, and management strategies are outlined for both acute communications and oroantral fistulas. Surgical techniques for repair include local soft tissue flaps, grafts, and use of the buccal fat pad flap. Immediate closure of communications less than 3 weeks old has a high success rate, while delayed or recurrent fistulas require surgical intervention.
This document discusses periodontal pockets and various techniques for treating them, including gingivectomy. It defines different types of periodontal pockets and explores gingivectomy techniques like surgical gingivectomy and electro surgery gingivectomy. It also summarizes flap procedures like the modified Widman flap and apically repositioned flap. Osseous surgery principles and techniques are outlined for reshaping alveolar bone. The document concludes that surgical therapy provides greater benefit than non-surgical therapy for deeper initial periodontal disease levels.
This document discusses various aspects of oral surgery preparation and procedures. It covers definitions of oral surgery, pre-surgical evaluation and preparation, asepsis and sterilization techniques, surgical staff preparation, incision types, flap design principles, tissue handling techniques, hemostasis, suturing, wound decontamination and debridement, and edema control. The document provides details on each topic to thoroughly outline the process of oral surgery.
Dental implants can be used to support crowns, bridges, or dentures for patients who are missing one or more teeth. There are several types of implants based on placement location and material. Implant surgery involves placing the implant fixture into the jawbone, with some procedures allowing the implant to heal below gum tissue or protruding above gum tissue. Regular dental visits are needed after implant placement to monitor bone and soft tissue health around the implants.
EWMA 2014 - EP458 CHRONIC WOUND OF THE LATERAL NAIL FOLD- THE HOLISTIC APPROACHEWMA
This document presents a holistic approach to treating chronic wounds of the lateral nail fold. The treatment involves minimally invasive surgery by a surgeon and podologist to remove overgrown tissue without removing the entire nail plate or matrix. Follow up care by a podologist applies dressings and nail braces to encourage healing and correct nail curvature over time. Results in patients treated with this method showed healing of wounds with no relapses, unlike standard surgical procedures. Close coordination between medical professionals enables an effective yet less invasive treatment approach.
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2. INTRODUCTION
Onychocryptosis (from Greek onyx nail and kryptos
hidden) also known as ingrown toenail, or unguis
incarnatus is a common and painful form of nail
disease.
It is most common in teenagers and young adults
during the second and third decades of life.
The commonest symptom is pain in the affected nail
which, if left untreated leads to infection, discharge and
difficulty in walking, greatly hampering the quality of life
of the individual.
3. Diagnosis is apparent and several treatment
approaches exist, ranging from a conservative
medical approach to extensive surgical
treatment options.
The therapeutic approach chosen is dictated
by the severity and stage of the ingrown toe
nail.
4. PATHOGENESIS
The widely accepted theory is that
onychocryptosis occurs when the lateral nail fold
is penetrated by the edge of the nail plate,
resulting in pain, sepsis and, later the formation of
granulation tissue.
Penetration is often caused by spicules of nail at
the edge of the nail plate, which incite an
inflammatory response.
The great toes are the most often affected.
5. Various theories have been proposed to explain
the aetiology of the ingrown toenail and they can
be broadly classified according to whether the
primary fault is the nail itself or the soft tissues at
the side of the nail.
One theory is that the nail is not the real culprit,
and it is actually the excess skin surrounding the
nail which is the real problem.
6. The persons who develop this condition have an
unusually wide area of tissue medial and lateral to the nail
and that with weight bearing, this tissue tends to bulge up
around the nail, leading to pressure necrosis.
Although it is still believed that the real defect lies in the
nail, the controversy of whether there is a nail plate
abnormality or overgrown nail folds still exists.
7. PREDISPOSING FACTORS
1. Poorly fitting shoes: Extrinsic
compression of the great toe by tight footwear
and narrow shoes places constant pressure
directly on the medial nail wall and indirectly
on the lateral wall as the great toe is pushed
against the second toe.
8. 2. Improperly trimmed toenails: The toenails should
be cut straight across, instead of rounded.
Cutting the nail too short will allow more bulging of soft
tissue leading to an inflammatory reaction and pressure
necrosis.
3. Excessive sweating: Excessive sweating and
maceration causes the skin of the nail folds to become
soft that can be easily penetrated by the nail.
9. 4. Nail infections: In tinea unguium or onychomycotic nails, the
nail plate becomes brittle resulting in easy breaking off of nail
spicules, making it easier for the nail to pierce the surrounding
skin.
5. Nail apparatus abnormalities: Improper shape of the nail
plate, thick nail folds, medial rotation of the hallux (eversion) and
reduced nail thickness can play a role in the development of the
ingrown toenail.
A nail that is more curved from side to side rather than being flat
is more likely to become an ingrown nail.
The most severe type is called a ‘pincer nail’.
10. 6. Others: Congenital onychocryptosis is an
infrequent form of presentation, believed to be
due to intrauterine trauma or hereditary
transmission.
11. CLINICAL FEATURES
Initially, there is pain and redness, followed by
swelling and pus formation. Granulation tissue
then forms, increasing the compression,
which adds to the swelling and discharge.
A recent classification by Mozena has
described four stages of onychocryptosis .
12.
13. DIAGNOSIS
Ingrown toenail is not difficult to diagnose.
Differential diagnosis includes subungual
exostosis, primary osteomyelitis of the
phalanx and tumors of the nail bed, including
subungual melanoma.
Various other tumors, primary or metastatic,
can mimic the presentation of an ingrown
toenail.
14. TREATMENT
There are various methods to treat ingrown toe nail.
The selection of technique depends on the stage and severity of
the condition, expertise of the surgeon and the previous
treatment of the patient, in cases of recurrence.
Mild to moderate lesions with minimal to moderate pain, little
erythema and no purulent drainage can be treated with
conservative therapies.
Moderate to severe lesions with severe, disabling pain,
substantial erythema and purulent drainage usually require
surgical intervention.
15. General Measures
Proper footwear with a “wide toe box” or “open
toe” should be adopted.
The patient should be instructed to cut the nail
straight across and avoid cutting back the lateral
margins in a curved manner.
The nail edge should extend past the tissue of the
lateral nail fold. Underlying pathogenic factors
such as hyperhidrosis, and onychomycosis should
be managed.
16. Soaking the affected toe and foot for 10 to 20
minutes in warm, soapy water, followed by a
topical antibiotic ointment gives relief.
Application of silver nitrate to the granulation
tissue may decrease inflammation.
Hydrogen peroxide and iodine can be used for
cleaning, predominantly in stage I ingrown toenail.
19. 1. Gutter splint or sleeve
technique
A gutter splint is prepared by slitting a small
appropriately cut sterilized vinyl intravenous drip
infusion tube from top to bottom with one end cut
diagonally for smooth insertion.
Under local anesthesia, the lateral edge of the nail
plate including the spicule is splinted with this
lengthwise-incised flexible plastic tube.
The splint is pushed proximally till the nail spicule is
totally covered by the split plastic tube.
20. The plastic tube is then attached with either adhesive
tape, cyanoacrylate adhesive or wound closure strips .
After splinting, patients experience instant relief of pain.
They are instructed to wash the toe once daily with,
povidone-iodine for up to 3 or 4 weeks.
The splinted spicule grows out without injuring the nail
fold and the granulation tissue subsides.
21.
22. 2. Cotton-wick insertion in the
lateral groove corner
Wisps of cotton are placed under the ingrown
lateral nail edge using a nail elevator or a
small curette.
23. 3. Band-aid method
One end of the tape is placed against the side of the
ingrown toenail, along the granulation tissue, and the
rest is twisted around the toe at an angle so that the
other end overlaps the first, but does not cover the
wound itself .
The principle is that by physically pulling the side of the
nail bed away from the nail, one can decrease pressure
while simultaneously improving drainage of
accumulated pus and drying of the wound.
24.
25. 4. Dental floss technique
This noninvasive technique is used in the
early stages of ingrown toenail.
Without local anesthesia, a string of dental
floss is inserted obliquely under the ingrown
nail corner and pushed proximally.
The lateral edge of the nail plate, including
the spicule, is covered and separated with it.
26. 5. Nail wiring
In this technique, two holes are made with 23-G needles
at the distal free edge of the nailplate.
An elastic wire is inserted until the degree of the nail plate
becomes less than 60°.
The wire is bent forward, cut with clippers, so that it does
not protrude from the nail end and the small hole made by
the needle is filled with an ethyl 2-cyanoacrylate adhesive
agent .
The elasticity of the wire helps in curing the deformity of
the ingrown nail.
27.
28. 6. Angle correction
technique
The principle of this procedure is to correct
the convexity of the nail by filing the whole
surface of the nail, reducing its thickness by
50-75%.
The procedure is repeated by the patient
every 2 months, making the nail thin and soft.
29. 7. Others
Using an acrylic artificial nail and a nail brace
are other conservative techniques that have
been used.
31. Local anesthesia of the great toe should be performed cautiously
to avoid vascular complications as toe necrosis has been
reported as a rare serious complication of ingrown toenail
surgery.
It has been suggested that metatarsal block is safer as
compared to a digital block as collateral circulation is well
developed, and the subcutaneous tissue is more expandable in
the metatarsal area as compared to great toe.
A 2% lignocaine solution is preferable as a smaller volume is
required. Contrary to popular belief, Krunic et al., suggest that
addition of epinephrine may reduce the need for a tourniquet and
produce better and longer pain control during surgery.
34. There are various surgical treatment options
for ingrown toenails, although none of the
techniques have been able to establish
themselves as the technique of choice.
The ideal surgical procedure should result in
a high level of patient satisfaction, both
functional and aesthetic, a rapid return to
normal activities, and a low rate of recurrence.
35. Excision of the spicule and
partial matricectomy: Suppan I
technique
It is carried out in individuals with a Stage I
ingrown toenail affecting the nail plate without
hypertrophy of the nail fold and in adults or elderly
patients, in whom tissue-regeneration capacity is
reduced and likelihood of recurrence is lower.
The technique consists of excision of the affected
portion of the toenail and partial mechanical
matricectomy (with curet or scalpel).
36. Chemical partial matricectomy:
Phenol-Alcohol technique
Phenolic ablation has a high success rate up to
90%.
It is less painful, has a lower morbidity and has a
higher success rate than surgical excision of the
matrix.
It is likely that there is some phenolic nerve
damage at the site of surgery, which provides a
degree of analgesia, but does not result in any
long-term deficit.
37. Indications for a phenolic ablation include stage I, stage IIa
disease, young or adolescent patients because they have great
tissue-regeneration capacity and diabetic patients with controlled
type 1 or 2 diabetes.
The phenol-alcohol technique is safe in diabetic patients who
have no vascular risk and have good control of their diabetes.
Although there is no reported systemic side effects after phenol
application for the treatment of ingrown nail, phenol application
results in chemical burn and intense inflammatory changes.
Though the recurrence rate is low (5%), post-operative
complications like delayed healing and oozing are more
common.
38.
39. Wedge resection of the toenail
and nail fold
This procedure can be carried out via the
aesthetic reconstruction technique or the
Winograd technique.
Both techniques are very similar and are
indicated for stage IIb and stage III
onychocryptosis .
40. The techniques involve excision of the
affected portion of the nail plate, partial
matricectomy and wedge extirpation of the
hypertrophic nail fold and the nail bed.
Winograd’s technique is a type of wedge
excision with more elaborate attention to the
removal of the lateral matrix horn and better
preservation of the
41. lateral nail fold, whereas in an aesthetic
reconstruction technique the aim is to reduce the
convexity of the nail fold, with more attention given
to the lateral nail fold.
The aesthetic reconstruction technique involves
complete removal of the nail plate and
debridement of the granulomatous tissue, after
which wedge-shaped ellipsis of skin and
subcutaneous tissue, lateral to the affected nail
fold, is removed.
42.
43. Total matricectomy
This procedure is indicated for stage IV
onychocryptosis in adult patients,
onychogryphosis, onychodystrophy and
chronic hypertrophy of the distal and lateral
folds.
Nail excision and total matricectomy with
phenol is performed.
44. Alternative techniques for
matricectomy
CO2 laser, radiofrequency and electrocautery for
matricectomy CO2 laser has been recommended
as an effective primary modality of treatment with
a success rate of 50–100%.
Well-established advantages of the CO2 laser
technique are less bleeding, reduced
postoperative pain, immediate sterilization of
infected tissue, and limited thermal damage to the
surrounding tissues.
45. Moreover, the possibility to selectively direct
the laser beam into the deep recesses of the
lateral horns of the matrix makes laser the
therapeutic modality of choice.
The disadvantage is that re-epithelialization
and healing of the tissues by secondary
intention takes 3–6 weeks.
46.
47. Decompression technique
This procedure entails unilateral soft tissue
resection of the nail fold combined with partial
nail plate avulsion technique without
permanent matricectomy.
No permanent injury is incurred on the matrix,
though recurrences are common.
48. Soft-tissue nail fold excision
technique
The procedure pioneered by Vandenbos and Bowers
was based on the assumption that the nail is not the
causative factor in development of the ingrown toenail.
This procedure does not touch the nail. After local
anesthesia, the soft tissue enveloping the nail is
excised widely in an elliptical manner.
It is important that all the skin at the edge of the nail be
removed.
49. The wound is left open to close by secondary intention.
Postoperative management involves soaking of the toe
in warm water three times a day for 15–20 minutes.
The wound heals by 4–6 weeks.
The advantage of this technique is the preservation of
the nail and its matrix, excellent cosmetic results, no
recurrences and high rates of patient satisfaction.
50. Role of antibiotics
Oral antibiotics are considered as an essential component
in the treatment course of ingrown toenails.
However, antibiotic necessity remains controversial. Some
physicians feel that instituting oral antibiotics before
performing a phenol matrixectomy or at the time of the
phenol matrixectomy reduces the risk of developing
further infection.
Other investigators have indicated that once the
offending nail is removed, the localized infection will
resolve without the need of antimicrobial agents.
51. If at all antibiotics are considered, they must
be efficacious against coagulase-negative
staphylococcal species, specifically
Staphylococcus epidermidis, which is the
most commonly cultured pathogen in infected
ingrown toenails.
52. Postoperative care and
analgesics
Typically post operative care includes,
advising the patient to avoid wearing shoes
for 3 days, and to keep the leg elevated for
24-48 hours.
The dressing can be removed by the patient
on the day after the surgery and is followed by
cleaning with betadine or epsom salt soaks
for 10-15 minutes, twice daily for a week.
53. Following the soaks the patient is advised to apply
antibiotic ointment and a small bandage.
Analgesic requirement depends upon the method used
to treat the ingrown toenail; usually analgesics
prescribed for 2-3 days are enough.
The patient can resume work usually after 48 hours.
The patient is called for follow-up after 1 week.