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Hi new to the arena and wanted to get other people's experiences of nail surgery in patients who are immuno compromised as it is an area not covered very well

 

As with any surgery, one must consider balance of risk.

There is a risk to doing NS on an immunocomprimised patient. But then there is also a risk to leaving that nail, if it regularly creates a wound in the toe which could ALSO become infected. One must consider the likelihood of the latter, any alternatives, and the long term prognosis of the patient. If they are immunocomprimised and likely to become much more so, and the toenail breaks the skin and causes infections regularly, then its probably a lower risk in the long term to do the surgery, carefully manage the wound, treating it as an ulcer, rather than treat a long succession of uncontrolled, unpredictable wounds over the next 10 years. If on the other hand they could be managed conservatively with minimal risk of breakdown, thats probably a better option.

 

Hi, your post caught my eye as I have just finished doing a nail surgery on a diabetic patient who is also on anticoagulants.

It was a problem I had hoped not to have to deal with, but in the end the patient became increasingly fed up with constant pain despite frequent routine treatment. As a private practitioner, I had even more to think about.

If this is the kind of dilemma you are facing, I would be happy to expand on this answer.

 

In any such cases, it is advisable to carry out an incisional technique under antibiotic cover. The reason is that 'clean' incisions heal faster than chemical burns and it is not appropriate to provide antibiosis over the longer period of healing following chemical ablation.

All the best

Bill