Toenail Avulsion Procedure Note

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PRE-OP DIAGNOSIS: _
POST-OP DIAGNOSIS: Same 
PROCEDURE: toenail avulsion
Performing Physician: _ 
Supervising Physician (if applicable): _
 
PROCEDURE: 
The area surrounding the skin lesion was prepared and draped in the usual sterile manner. The patient is placed in the supine position, with the knees flexed (foot flat on the table) or extended (foot hanging off the end of the table).
The toe was prepped with povidone-iodine solution. A standard digital block was performed, using a 10-mL syringe and a 27-gauge needle. (About 2 to 3 mL of lidocaine on each side of the toe is usually sufficient for adequate anesthesia. A wait of five to 10 minutes allows the block to become effective. )
A sterile tourniquet was applied for the shortest time possible.
The toe was rewashed with surgical solution.
A nail elevator was slid under the cuticle to separate the nail plate from the overlying proximal nail fold.
The lateral 20-30% of the nail plate was cut free using bandage scissors and gently pulled free with a hemostat.
If matrictectomy was performed, electrocautery ablation was used to destroy the nail-forming matrix beneath the area where the nail plate has been removed.
Vaseline impregnated gauze was applied followed by a bulky gauze dressing. 
 
Followup: The patient tolerated the procedure well without complications.  Standard post-procedure care is explained and return precautions are given.
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