Caleb Foster
Nail removal is a procedure that can be carried out safely under local anaesthesia, although some patients may prefer to be put under general anaesthesia. The procedure is performed when a large portion of the nail is diseased, damaged, or causing the patient pain. It involves numbing the finger or toe and removing some or all of the nail plate (the hard part of the nail). The skin below the nail plate may also be removed. Following the procedure, patients are advised to keep their bandage dry and clean for a number of hours, and to elevate their hand or foot to reduce pain and swelling.
| Characteristics | Values |
|---|---|
| Procedure | Nail avulsion or nail biopsy |
| Purpose | Treat nail problems that did not get better with other treatments, including infection, growths, severe injury, ingrown toenail, redness, swelling, oozing, pain, infection, or odour |
| Anaesthesia | Local ring block, procedural sedation, or general anaesthesia |
| Recovery | Takes about 6 months for a fingernail to regrow and about 1 year for a toenail; the new nail is often normal |
| Post-procedure care | Keep the bandage on for a certain period, soak the affected area in lukewarm water, wash the wound, check for discoloration or redness, apply ointment, and change the bandage once or twice a day until the wound is healed |
| Pain management | Take acetaminophen (Tylenol®) or extra-strength acetaminophen; avoid aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil®) or naproxen (Aleve®) unless advised by a healthcare provider |
| Abnormal growth | When the nail grows back, it may be odd in shape and appearance |
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What You'll Learn
Anaesthesia options
Nail removal is a common procedure, often performed to treat ingrown toenails, infections, or injuries. It involves the careful separation of the nail from the nail bed, either partially or completely. While nail removal is generally a safe procedure with few complications, proper anaesthesia is crucial to ensuring patient comfort and safety.
In some cases, a nerve block or digital block may be used in conjunction with local anaesthesia. A nerve block involves injecting anaesthetic medicine close to a nerve or group of nerves, providing extended pain relief. A digital block, often performed with lidocaine, numbs the entire finger or toe by blocking nerves at the base of the digit. A tourniquet may also be applied to minimise bleeding and enhance the effects of anaesthesia.
For young children undergoing nail bed repair, general anaesthesia may be necessary. Additionally, some doctors may offer patients a sedative or twilight anaesthesia during ingrown toenail surgery to ensure comfort.
It is important to note that individuals with a history of anaesthesia complications or weakened immune systems may be at a higher risk for complications. Therefore, patients should discuss their medical history and any concerns with their doctor to determine the most suitable anaesthesia option for their nail removal procedure.
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Nail avulsion procedure
Nail avulsion is a frequently undertaken yet simple procedure that involves the removal of some or all of the nail plate (the hard part of the nail). It can also be used to remove the skin below the nail plate. This procedure can be performed surgically or chemically. The surgical method involves a distal or proximal anatomical approach, with the former being the most frequently used technique. In this technique, the nail plate is released from its attachment to the nail bed at the hyponychium. The proximal approach involves separating the nail plate from the proximal nail fold (PNF) and then moving distally for complete separation.
Chemical nail avulsion, on the other hand, uses ointments containing urea to avoid the complications of surgery. For example, in the treatment of locally infected ingrown toenails, chemical avulsion is used in combination with matricectomy using phenol. This method has been shown to have lower recurrence rates than excision of the nail matrix.
Nail avulsion is often recommended when other treatments for nail problems have failed. These nail problems could include infections, injuries, ingrown toenails, or issues caused by cancer treatment, such as redness, swelling, oozing, pain, infection, or odour. The procedure can also be used for diagnostic purposes, such as exploring the nail bed and nail matrix to look for pathologies or performing a biopsy to check for abnormal cells.
Before the procedure, patients are typically given local anaesthesia to numb the affected area. Additionally, a nerve block may be placed in the finger or toe to provide extended pain relief. The area is then washed with surgical soap or alcohol. Once the nail is removed, an antibiotic ointment and dressing are applied to the wound, and the patient may be prescribed antibiotics to take at home. It is important to keep the bandage dry and change it as instructed. Patients should also refrain from swimming or strenuous exercise for several weeks after the procedure.
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Healing and recovery
While it is possible to remove your nail bed, it is a serious procedure that should only be carried out by a healthcare professional. The procedure is often carried out under local anaesthesia, but some patients may opt for general anaesthesia. After the procedure, the patient will be given an antibiotic ointment and dressing for their wound.
During the first 48 hours after the procedure, the patient should keep their affected arm or leg raised as high as possible above heart level. This will help with pain and swelling. The patient should try to keep their arm or leg raised as often as possible for the first week. If there is any bleeding, press firmly on the wound with a clean gauze pad for 15 minutes. If the bleeding does not stop after 15 minutes, press firmly for another 15 minutes. If the bleeding still does not stop, contact a healthcare professional.
Patients can take acetaminophen (Tylenol) to help with pain or discomfort if needed. It is advised to not take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or naproxen (Aleve) unless advised by a healthcare professional, as these medicines can increase bleeding.
The patient should soak their affected finger or toe in lukewarm water for 15 minutes to prevent the bandage from sticking to the wound. They should then gently remove the bandage, wash the wound, and pat it dry with clean gauze. The patient should check for blue or purple discolouration or redness. If there is any discolouration or redness, they should contact their healthcare provider. The patient should then apply ointment to their wound and cover it with a new bandage.
The patient should keep the tip of their finger or toe open to the air so they can keep checking for discolouration or redness. They should change their bandage once or twice a day until the wound is healed, which usually takes 5 to 7 days. It takes about 6 months for a fingernail to regrow and about 1 year for a toenail. The new nail often looks normal.
To prevent stiffness in their fingers, patients can do finger exercises. They should touch the tips of each finger with their thumb and then move their wrist forwards and backwards.
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Surgical nail removal
During the procedure, the patient's hand is positioned supine with the arm abducted and the palm facing down. The finger is then scrubbed and draped in a sterile fashion before the administration of local anaesthesia. Once the anaesthesia has taken effect, a tourniquet is applied at the base of the finger to minimise bleeding. The nail is then gently separated from the nail bed using curved Iris scissors or a small periosteal elevator. After the nail is removed, the wound is dressed with antibiotic ointment and bandaged.
Following the procedure, patients may experience pain, throbbing, swelling, bleeding, discharge, or sensitivity in the affected area. To manage these symptoms, it is recommended to keep the affected arm or leg elevated above heart level for the first 48 hours. This helps with pain management and reduces swelling. Patients should also regularly change their bandages and apply antibiotic ointment to the wound to prevent infection and promote healing.
The regrowth of nails after surgical nail removal can take a significant amount of time, with fingernails taking about six months and toenails taking up to 18 months to fully regrow. The new nail often appears normal. Surgical nail removal provides an opportunity to directly apply antifungal medications to the nail bed, increasing the chances of curing nail infections.
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Nail bed repair operation
Nail bed repair is a short operation performed to treat a damaged nail bed. The nail bed is the tissue that sits underneath the fingernail and helps the nail grow normally. The injury is common and occurs when fingers or toes are crushed by heavy objects or cut by sharp objects.
During the procedure, the finger is numbed using local anaesthesia, and the nail is removed to access the nail bed. The nail bed is then repaired with dissolvable stitches, and the nail is reattached if possible. After the operation, the patient can usually go home the same day. It is normal to experience some pain and swelling, and it is recommended to keep the hand elevated to reduce these symptoms. Antibiotics may be prescribed to prevent infection.
The dressing applied after the procedure should be kept dry and left in place for about one week until the patient is seen in the dressings clinic. Patients may shower or wash their hands by taping a plastic bag around the wrist. Minor bleeding through the dressing is normal, but medical attention should be sought if there is heavy bleeding.
It can take around 3 to 9 months for a new nail to grow back, and it may initially appear abnormal. To prevent stiffness in the fingers, patients can perform exercises such as touching the tips of each finger to the thumb and moving the wrist back and forth.
In some cases, home remedies or conservative treatments may be sufficient for nail bed repair. This involves covering the nail bed to prevent drying and promote tissue regeneration, allowing for complete nail repair in about 6 weeks. However, for larger nail bed defects, reconstructive techniques may be necessary.
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Frequently asked questions
A nail avulsion is a procedure to remove some or all of the nail plate (hard part of the nail) and possibly the skin below. It is performed under local anaesthesia and may require a nerve block in the finger or toe.
Nail removal is typically a last resort when other treatments have failed. It is usually performed when a large portion of the nail is diseased, damaged, or causing severe pain. It can also be done to treat nail problems caused by cancer treatment.
First, an injection is given to numb the area. Then, a tool is used to loosen the skin around the nail and separate it from the nail bed. If only a part of the nail is affected, only that portion is removed. After the nail is taken out, an antibiotic ointment is applied, and the area is dressed.
You can expect some pain, swelling, and bleeding. Keep the dressing on for the advised amount of time, and then soak the affected area in lukewarm water before removing it. Change the bandage once or twice a day until the wound is healed, which typically takes 5-7 days.
It takes about 6 months for a fingernail to regrow and approximately 1 year for a toenail. The new nail may be abnormal in shape and appearance initially, but it often returns to normal within 9 months.
