[Surgery of the nail region]

Operations of the nail apparatus are done under sterile conditions and regional anaesthesia and in local anaemia. The knowledge of the complicated anatomy and physiology is the prerequisite for good surgical results. Nail extractions are commonly done too frequently. Subungual haematomas require a different treatment depending on the severity. Removal of the proximal third of the nail plate quickly clears acute paronychia resistent to antibiotics. The treatment of choice for the ingrown toenail is the surgical narrowing of the matrix. Kind and size of subungual tumours determine their surgical treatment. Diagnostic nail biopsies are best performed laterally.

Factors related to the resolution of treated hand infections

One hundred thirty-eight patients with acute hand infection (81% deep) treated from 1970 to 1980 in hospital were reviewed. Resolution time of infection was slow, 8 days or longer in 57% of 135 patients and 15 days or longer in 28%. Such slow resolution occurred in infection of closed anatomical spaces and included 50% of all pulp space and joint infections, 23% of tenosynovitis, and 24% of subcutaneous dorsal had infections. There was a direct correlation between increasing treatment delay and slower resolution of infections in pulp spaces, palmar spaces, joints, and tendon sheaths. If the mean treatment delay was greater than a brief 2 1/2 days, 69% of tenosynovitis showed delayed resolution. Other factors associated with the rate of resolution were adequacy of surgical drainage, efficacy of antibiotics, and associated diabetes mellitus.

The treatment of herpetic whitlow--a new surgical concept

Characteristics of cutaneous lesions caused by herpes simplex virus (HSV-1) are: Acquired by skin-to-skin contact; humans are the only natural host. Often on the hands of health care personnel. Painful swelling, erythema, vesicles, and ulcerations. Possible involvement of cutaneous digital areas of paronychium, eponychium, and subungual matrix. Similar to a bacterial (septic) or fungal felon. Self-limiting--14- to 21-day course. An aseptic felon, which provides a contraindication to surgical incision and drainage of the deep pulp space. Severe pain: the major complaint from all patients. Relieved of pain by decompression of the involved nail bed, either by segmentally excising or perforating the overlying nail or both to unroof the vesicles.

[Surgical treatment of osseous paronychia in children]

Bony panaritium was treated in 48 children from 1 to 15 years of age by a new method consisting in the early and careful removal of the purulent-necrotic substrate and making the continuous suture. The most rational access to the injured phalanx (oval and semioval incisions) were found. Local regional forms of anesthesia (conduction and intraosseous anesthesia) and general anesthesia were used. The analysis of remote results has shown the children treated by this methods to be able to work, play and perform fine and exact manipulations.

[Metastasising squamous-cell carcinoma of the skin in a ten-year-old girl]

Because of recurrent paronychia of the right thumb "granulation" tissue was removed from the nail-bed of a ten-year-old girl. Histological examination revealed a cornified squamous-cell carcinoma. About five months later a lymph-node metastasis was found in the right axilla. After radical dissection of the axillary region further lymph-node metastases were found, as well as a lymphangitic carcinosis with tumour infiltration in the veins. Despite telecobalt radiation there were recurrent retastases which could no longer be removed by operation. Two years after the diagnosis the girl died. Necrospy revealed diffuse tumour infiltration of the soft tissue of the axilla, upper arm, shoulder, neck and thoracic wall on the right, including the breast tissue, with thoracic para-aortic-abdominal and left-sided axillary lymph-node metastases, and lung and pleural metastases bilaterally.