Perioperative management in nail surgery: An international Delphi consensus statement

Nail surgery is a cornerstone in the diagnostic and therapeutic management of nail disorders, yet perioperative practices vary widely because of limited comparative evidence and the absence of comprehensive guidelines.

To develop an international expert consensus providing practical recommendations for perioperative management before, during, and after nail surgery.

A literature review on nail surgery techniques, perioperative management, complications, and postoperative care was performed. Key clinical topics were identified and addressed through a Delphi process involving 10 dermatologists with expertise in nail surgery from multiple countries. Consensus was predefined as ≥70% agreement or disagreement on a 5-point Likert scale across 3 rounds.

Panelists evaluated 260 Likert-scale items derived from 50 open-ended questions. Consensus was achieved across domains, including antibiotic prophylaxis, bleeding risk management, anesthesia techniques, antisepsis, tourniquet use, postoperative analgesia, dressings, wound healing, follow-up strategies, and prevention of long-term complications such as nail dystrophy and functional impairment. Selected items remained without consensus, identifying areas requiring further research.

Recommendations are based on expert opinion in areas with limited high-quality comparative evidence.

This international Delphi consensus provides guidance to support safer and standardized nail surgery and may help reduce practice variability pending stronger prospective evidence.