๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
PREOPERATIVE EVALUATION
PREOPERATIVE EVALUATION
A thorough preoperative discussion with the patient is one of the most important elements of successful nail surgery. The discussion should include preparation by the patient for surgery as well as anticipated postoperative care. Describing the anatomy of the nail unit, the usual rate of nail growth and the patientโs specific surgery prepare the patient for a postoperative course that meets their expectations. Preoperative discussion should also include a discussion of risks of any nail surgery including pain, infection, bleeding, scar, nerve damage, nondiagnostic biopsy, and permanent nail dystrophy. The actual rate of these complications varies by surgical approach and the expertise of the surgeon.
The preoperative plan takes into account any peripheral vascular compromise that might be encountered in associated conditions such as Raynaudโs phenomenon, peripheral vascular disease, and diabetes. Smoking cessation is known to improve the microvasculature, leading to reduced ischemic injury and improved wound healing.2,3 Any medically necessary anticoagulants are continued, as the risk of stopping anticoagulation outweighs the surgical benefits.4,5
As with all surgeries, the patient should be asked if they have any allergies or adverse reactions to anesthetics, wound care materials, and/or pain medications planned for use in their surgery. Rarely, patients may benefit from oral anxiolytics.6 If surgery is to be performed on a toenail, the patient should be advised to bring footwear with adequate space to accommodate the postoperative dressing and a driver to escort them home safely. Elevation of the surgically manipulated limb is mandatory in order to limit postoperative pain and edema.