RESUMO
There are an increasing number and variety of dermatologic surgical procedures performed safely in the office setting. This evidence-based guideline addresses important clinical questions that arise regarding the use and safety of local anesthesia for dermatologic office-based procedures. In addition to recommendations for dermatologists, this guideline also takes into account patient preferences while optimizing their safety and quality of care. The clinical recommendations presented here are based on the best evidence available as well as expert opinion.
Assuntos
Assistência Ambulatorial , Anestesia Local/normas , Anestésicos Locais/administração & dosagem , Procedimentos Cirúrgicos Dermatológicos , Dor/prevenção & controle , Administração Tópica , Anestesia Local/efeitos adversos , Anestesia Local/métodos , Anestésicos Locais/efeitos adversos , Epinefrina/administração & dosagem , Medicina Baseada em Evidências , Humanos , Hialuronoglucosaminidase/administração & dosagem , Bloqueio Nervoso , Preferência do Paciente , Bicarbonato de Sódio/administração & dosagem , Vasoconstritores/administração & dosagemRESUMO
Nail procedures require an effective and reliable approach to anesthesia of the distal digit. Several techniques have been described in the literature. Herein, the relevant anatomy of the nail unit, pain pathways, anesthetic options, and several injection approaches to achieve complete anesthesia are reviewed. Also considered are the potential pitfalls and complications and their management. Ultimately, the physician's approach must be individualized to the patient, procedure, and setting.
Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Doenças da Unha/patologia , Doenças da Unha/cirurgia , Unhas/patologia , Bloqueio Nervoso/métodos , Anestesia Local/efeitos adversos , Anestesia Local/instrumentação , Biópsia , Epinefrina/administração & dosagem , Humanos , Agulhas , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/instrumentação , Dor/prevenção & controle , Temperatura , Vasoconstritores/administração & dosagemRESUMO
BACKGROUND: Among US dermatologists, Mohs surgeons perform most of the nail surgeries. The specific practice patterns and safety precautions have not been formally studied. OBJECTIVE: To study the practice patterns, safety precautions, and complications of this group when performing nail surgery. METHODS: A survey was sent electronically to all members of the American College of Mohs Surgery Listserv. The survey evaluated the demographics of the surgeons, the types of surgery performed, the techniques for obtaining a bloodless field, and complications. RESULTS: Those surgeons who performed more procedures in training tended to continue that practice and performed more surgeries when in practice, as did surgeons with greater time since completing fellowship. Complications were rare. CONCLUSION: The data herein support that nail surgeries performed by Mohs surgeons are safe, with minimal complications, despite a broad range of approaches to obtaining a bloodless field and with a variety of procedures performed.
Assuntos
Anestesia Local , Cirurgia de Mohs , Unhas/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Neoplasias Cutâneas/cirurgia , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Epinefrina/administração & dosagem , Inquéritos Epidemiológicos , Humanos , Cirurgia de Mohs/efeitos adversos , Cirurgia de Mohs/estatística & dados numéricos , Prevalência , Neoplasias Cutâneas/epidemiologia , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
This paper provides an introductory overview of nail surgery, including basic principles, anesthesia, wound dressings, and several common nail procedures. In detail, it reviews how to achieve complete anesthesia and hemostasis, perform matrix injection, punch biopsy of the plate, bed, and matrix, and nail fold biopsy, with practical tips and suggested surgical indications.