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Master Thesis

Complications précoces en chirurgie unguéale : étude prospective multicentrique de 430 cas

Abstract : As for dermatologic surgery, nail surgery exposes to post-operative pain and complications. Few studies are available in the international literature. Our study aims to determinate the incidence of complications and post-operative pain. This observational prospective and multicentric study has been performed from November 2015 until April 2016 in 10 departments or private offices in France and Belgium. 430 patients were included. The incidence of complications was 18,8 %: 10,8 % of sensory disturbance, 5,1 % of post-operative infections, 1,4 % of haemorrhagic complications and 1,1 % of delay in wound healing. Pain was maximal during the first 48 hours (EVA 1 - 3: 43,8 %, EVA 4 - 6: 25,5 %, EVA 7 - 10: 8,5 % and no pain for 22,1 %) then decreased (no pain: 53,7 %, EVA 1 - 3: 24,5 %, EVA 4 - 6: 16,8 % and EVA 7 - 10: 4,8 %). 95% of patients were satisfied with their analgesic prescription. We identified 7 predictive factors of moderated to severe pain: female gender, manual profession, digital location of the nail pathology, the type of local anaesthetic: lidocaine without epinephrine verus ropivacaine, operating indication, surgical technique and the use of a digital tourniquet over than 12 minutes. A wide conventional surgery as flaps, removal of exostosis or excision of the whole nail apparatus were the most painful. Treatment of Malalignment of the big toe-nail, treatmen! t of myxoid cysts and exostosis were the most painful indications. To conclude, the total incidence of complications after a nail surgery procedure in this prospective study is 18,8%. This incidence is higher than in facial skin surgery but with almost 10% of sensory disturbance particularly dysaesthesia after fingertip surgery. This study identifies several situations associated with a higher risk of pain and complications. Our results allow therefore a better counselling of the patients and a more personalized approach for the post-operative care in nail surgery.
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Master Thesis
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Submitted on : Saturday, April 1, 2017 - 12:23:05 PM
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Nina Sokolowsky. Complications précoces en chirurgie unguéale : étude prospective multicentrique de 430 cas. Médecine humaine et pathologie. 2017. ⟨dumas-01499896⟩

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