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Nail surgery procedures are usually undertaken to provide the permanent resolution of a variety of acute and chronic painful nail pathologies which are reasonably difficult to manage conservatively. Nail problems are either congenital or acquired due to post traumatic, infective, or psoriatic in origin including various nail conditions such as onychomycosis, onychogryphosis, onychocryptosis, and onychosis.

Mostly dystrophic nail deformities are corrected with a partial nail avulsion where a minimum portion of the nail is removed to resolve a problem. Sometimes, even the entire nail is avulsed to treat more severe deformation of the nail. Both of these procedures i.e. partial and total nail avulsions are generally performed under local anesthesia and may also need chemical ablation of the affected nail matrix to avoid recurrence of the infection. In traumatic nail injuries, nail avulsions may be performed to assess the stability of the nail bed and to release sub-ungual hematoma after the failure of puncture aspiration.

Selection of Patients
Any patient who is diagnosed with an acute or chronic nail condition and cannot be managed conservatively is suitable to undergo nail surgery.

Standard Operating Procedure for Nail Surgery Procedural Pathway

Procedure for Nail Surgery
PRE-OPERATIVE ASSESSMENT PROCEDURE

Ref: http://www.wirralct.nhs.uk/attachments/article/28/MMSOP36Nailsurgeryprotocols26Feb2013.pdf

Various indications where Nail Avulsion is used as an adjunct therapy as described below:

Surgical Matricectomy:
It refers to the overall excision of the nail matrix which results in permanent nail loss. Matricectomy is indicated for the management of onychogryphosis, onychosis, congenital nail dystrophies and various other chronic painful nail ailments

Onychocryptosis (Ingrown toe nail): Common indications for an ingrown toenail (Onychocryptosis) include significant pain or infection. The most common procedure to treat locally infected ingrown toenails such as Onychogryphosis (a deformed and curved nail) or chronic, recurrent paronychia (inflammation of the nail fold); is a partial separation of the lateral edge of the nail followed by chemical matricectomy by utilizing 80-88% phenol (phenolization).

Chronic onychomycosis: In this case, total nail avulsion is an effective procedure, especially for patients with single or oligo-onychomycosis.

Traumatic nail injuries: Nail Avulsion is used to evaluate the stability of the nail bed or releasing a subungual hematoma after puncture aspiration is failed. Severe stabbing or plantar flexor injuries can be treated by removing the nail plate or the proximal portion of the nail plate and then following-up with cleansing, debridement, and inspection.

Chronic paronychia: This extremely recalcitrant dermatosis is typically prevalent in housewives. In Chronic paronychia patients, primarily a surgical approach forms a vital part of management. Here an en-bloc excision of the PNF along with a total, or partial nail plate avulsion can be a useful procedure in chronic, recalcitrant paronychia, especially where the PNF is fibrosed or thickened.

Warts: Mostly affects children and young adults, usually caused due to HPV-1, 2 and 4. Partial or complete nail avulsion is generally performed for digging into the extent of disease of nail bed or matrix with HPV and also to make sure complete eradication of diseased tissue.

Tumors: A combination of Nail plate avulsion along with nail bed excision forms the treatment for the major tumors such as Onychomatricoma, Glomus tumor, and various other Melanoma and non-melanoma cancers, pyogenic granuloma, fibrokeratoma and exostoses.

Recovery after Nail Surgery
Once your nail is removed, you may have to most likely wear a Band-Aid or bandage for two weeks, with somewhat limited motion. You may be advised to keep your foot elevated as much as possible.

In the first night, you may feel some pain and throbbing which can be easily controlled with Ibuprofen or Acetaminophen. Usually, it may take a few days to about two weeks for complete recovery to resume all your normal activities.

At Mediclinic, our specialist cosmetic surgeons have years of expertise in delivering advanced nail surgery procedures including the removal of infected and damaged toenails efficiently at an affordable cost.