Pengenalan asas mengenai NAIL AVULSION

1. NAIL AVULSION
Disediakan Oleh : Nassruto

2. Objektif
• Mengenalpasti keadaan kuku untuk dilakukan avulsi
• Menyenaraikan alat kelengkapan yang diperlukan
• Menerangkan kaedah Wedge Excision & Nail Bed
Ablation Procedure
• Menggunakan pengetahuan & pengalaman untuk
melakukan avulsi kuku pesakit bila melakukan
penempatan klinikal

3. Indikasi
• Ingrowing toenail ( ony-chocryptosis )
• Kuku cedera & longgar
• Onychogryposis (deformed, curved toenail),
• Onychomycosis (fungus)
• Chronic or recurrent paronychia (infalamasi dan bengkak
pada lipatan kulit dan tisu yang mengelilingi kuku)

4. Ingrown Toe nail

5. Nail Wedge Resection-
• Traditionally known as a Winograd procedure, is a
more invasive technique that involves sharp excision
of the nail matrix via blade and then sutures are used
to close the wound, (Leahy, et al 1990).
• This procedure involves splitting and removing an
edge of nail one-fourth inch long, excising or
curetting away the matrix and nail bed and removing
a strip of the nail fold, to create a semielliptic wedge
down to bone.
• The margins are then undermined and the incision is
closed with sutures (McGlamry et al, 2001).

6. Partial Nail Avulsion with
Phenolisation
• Is a less invasive technique that involves removal of
the nail piece and then the nail matrix is cauterised
with phenol to prevent any regrowth of nail (Tait and
Tuck, 1987).
• This is performed under local aesthetic mainly in the
day surgery.
• This technique is predominantly used by Podiatrists
and
• Podiatric surgeons, and is not well known in the
general medical community,(Clammy et al, 2001).
• The amount of time the phenol is applied to the nail
matrixvaries according to the literature, but the
minimum time is 1 minute
-

7. Alat Alat Pembedahan
• Picagari dan jarum
• Lignocaine 1-2%
• Povidone Iodine
• Paraffin Tulle
• Pembalut – 2 inci
• Thwaites Nail Nipper
• Tiub Getah - Torniquet
• Gunting – stich/endGunting – stich/end
sharpsharp
• Scaple bladeScaple blade
• Forsep arteri – 2Forsep arteri – 2
pasangpasang
• Nail ChiselNail Chisel
• Wooden applicatorWooden applicator
• Strip Getah -Strip Getah -
TorniquetTorniquet

9. Prosedur Eksisi Wedge

10. Prosedur Eksisi Wedge

14. Complications
• Nail deformity,
• Bleeding
• Recurrence of the original condition
• Infection

15. Advise
• The patient should limit activity, keep the affected
foot elevated for 12 to 24 hours, and keep the dressing
in place for 24 hours. An NSAID can be used to
control pain. After this period, the patient can return
to activities and walking as tolerated and should soak
the affected toe in warm water for 20 minutes, pat it
dry with a clean towel or gauze, and apply antibiotic
ointment twice a day for the next 4 days. Advise the
patient to expect sterile exudative discharge from the
nail bed for several weeks. Explain the signs and
symptoms of infection, and instruct the patient to
contact your office immediately if any occur.