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Perioperative management in nail surgery: An international Delphi consensus statement.
Andrea Sechi1, Luca Valtellini2, Kendall Billick3
1Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Journal of the American Academy of Dermatology
|May 15, 2026
Summary
This study established international expert consensus on nail surgery perioperative care, offering practical recommendations for safer, standardized procedures. These guidelines aim to reduce practice variations in nail surgery management.
Area of Science:
- Dermatology
- Surgical Procedures
Background:
- Nail surgery is crucial for nail disorders but lacks standardized perioperative practices.
- Variability in current practices stems from limited comparative evidence and guidelines.
Purpose of the Study:
- To create international expert consensus recommendations for nail surgery perioperative management.
- To provide practical guidance for before, during, and after nail surgery.
Main Methods:
- A comprehensive literature review on nail surgery was conducted.
- A Delphi process involving 10 international nail surgery experts was employed.
- Consensus was defined as ≥70% agreement/disagreement via a 5-point Likert scale over three rounds.
Main Results:
- Consensus was reached on 260 items across key areas like antibiotic prophylaxis, bleeding management, anesthesia, antisepsis, tourniquets, analgesia, dressings, and complication prevention.
- Areas lacking consensus were identified for future research.
- Expert opinion guided recommendations due to limited high-quality evidence.
Conclusions:
- An international Delphi consensus provides guidance for safer, standardized nail surgery.
- These recommendations aim to decrease practice variability in nail surgery.
- Further prospective evidence is needed to strengthen these guidelines.
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