Just To Be Clear

It’s a light week here in NYC, and time for some light blog-fare. If you have been here, you have slogged through a snowstorm that wasn’t all it was forecasted up to be, and now we are left with a slushy icy mess and one more snow day checked off the school calendar. Days off get me thinking, and with a little inspiration from my more inquisitive patients, we are finally able to answer the question- does fingernail polish need to be removed before foot, or any other, surgery?

Surprisingly, the research on this topic- which seems to be accepted as a general practice for any time of surgery- is not extensive. I was also surprised to learn that there is research into whether surgeons should remove nail polish or jewelry before surgery. And I’m talking to you ladies on this one; far be it for me to judge, but I’m just not a fan of nail polish on the fellas. The consensus among the community of people who consider these matters, which consists of some surgeons, nurses and a lot of policymakers and lawyers, is that nail polish inhibits the accurate capture of pulse oximetry readings from the fingertips, and for obvious reasons it’s important to know the percentage of blood oxygenation at all times during surgery and maintain such oxygenation at as close to 100% as possible. Fingernail polish may inhibit the sensor on the fingertip reader, and can also obscure the appearance of the nails which can be assessed by an anesthesiologist to ascertain the blood oxygenation, i.e. blue nails are bad. There is also the matter of dirt and bacteria that finger or toenail polish may harbor. The problem with all this is that there is no real evidence that nail polish contains significant amount of germs – both on the surgeon and the patient, and studies have not demonstrated a significant difference in infection rates during cases with and without nail polish. And the pulse oximetry concern is likely not valid either as the sensor is able to operate through nail polish, and if your anesthesiologist chooses to ignore the very sophisticated, accurate, and expensive sensors that constantly monitor all vital signs throughout surgery in favor of the appearance of fingernails or toenails, then it might be time to consider a different anesthesiologist.

I don’t quite want to cast this into the dustbin of medical myths, however I remain highly skeptical.   As your NYC foot surgeon I will continue to defer to the all-knowing, wise, sage nurses and operating room managers of superior intellect when they instruct my patients to ruin a perfectly good mani-pedi, but I’ll fight for you ladies- and maybe even you fellas- passionately.

See you in the office.

Ernest Isaacson