Perioperative management in nail surgery: An international Delphi consensus statement

BACKGROUND: 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. OBJECTIVE: To develop an international expert consensus providing practical recommendations for perioperative management before, during, and after nail surgery. METHODS: 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. RESULTS: 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. LIMITATIONS: Recommendations are based on expert opinion in areas with limited high-quality comparative evidence. CONCLUSIONS: This international Delphi consensus provides guidance to support safer and standardized nail surgery and may help reduce practice variability pending stronger prospective evidence.