Isla Bennett
Nail removal is a procedure that involves removing some or all of the nail plate (the hard part of the nail) and can also involve removing the nail bed, which is the skin below the nail plate. It is often done to treat nail problems such as infections, injuries, or deformities. When a nail separates from the nail bed, it will not reattach, and the treatment involves cutting away the separated nail and allowing a new nail to grow back in its place. This process can take up to 6 months for a fingernail and up to 18 months for a toenail to regrow.
| Characteristics | Values |
|---|---|
| Nail removal procedure | Nail avulsion |
| Nail deformities requiring nail removal | Infection, self-mutilation, tumor, trauma, ingrown toenail |
| Nail bed repair | Short operation involving numbing the finger, removing the nail, repairing with dissolvable stitches |
| Anaesthetic | Local or general |
| Post-procedure care | Keep the wound dry, change the bandage regularly, soak the wound in lukewarm water, apply ointment, cover with a new bandage |
| Nail regrowth time | 6 months for fingernails, 9-18 months for toenails |
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What You'll Learn
Nail bed repair surgery
The surgery involves numbing the whole finger and removing the nail to access the nail bed. The nail plate is carefully separated from the underlying sterile and germinal matrix soft tissue and soaked in a betadine solution. The nail bed is then repaired with dissolvable stitches, usually with a 6-0 absorbable suture like Vicryl Rapide. The removed nail plate may be trimmed and used to splint the eponychial fold to facilitate the growth of the new nail plate.
After the surgery, it is important to keep the hand elevated to reduce pain and swelling. Take regular painkillers such as paracetamol and ibuprofen for 1-2 days. The dressing should be kept on until the patient is seen again in the dressings clinic after about one week. It is recommended to avoid contact sports and activities involving sand or grit for two weeks.
It takes a long time for the nail to recover fully. Patients can expect a new but abnormal nail by 3 months, and the return of a normal nail can take around 9 months. To prevent stiffness in the fingers during recovery, patients are advised to do finger exercises as often as possible.
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Removing a nail that's partly attached
If you have a nail that is partly attached, it is likely that you are experiencing onycholysis, a condition where your nail separates from its nail bed. This often occurs after an injury to the nail, but it may also be caused by a fungal infection, nail psoriasis, or an iron deficiency.
If you are experiencing onycholysis, it is important to know that the detached section of your nail cannot be reattached. However, treatment can keep new nail growth attached to your nail bed. If the cause is a fungal infection, your healthcare provider may prescribe oral or topical antifungal medication.
To remove a nail that is partly attached, you can follow these steps:
- File any sharp edges smooth or trim the nail to prevent it from catching and tearing further.
- Soak your finger or toe in cold water for 20 minutes to soften the nail and surrounding skin.
- Using nail clippers, nail scissors, or cuticle scissors, carefully trim off the detached part of the nail. Take care not to cut the healthy nail or the skin underneath. If you are uncomfortable trimming the nail yourself, please seek professional help.
- Apply a thin layer of petroleum jelly, such as Vaseline, to the exposed nail bed and surrounding skin.
- Cover the area with a non-stick bandage or adhesive tape to protect it until the nail has grown out enough to protect the finger or toe.
- Keep the area clean and dry to prevent infection while you wait for a new nail to grow.
It is important to be gentle and careful throughout the process to avoid causing further damage or infection. If you notice any signs of infection, such as increasing pain, swelling, or discharge, seek medical advice promptly.
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Avoiding further damage to the nail bed
To avoid further damage to the nail bed, it is important to understand the different types of nail bed injuries and how to treat them.
Nail bed injuries are common and can occur when a heavy object crushes or hits the fingers or toes, resulting in a subungual hematoma, which looks like a bruise under the nail. If you experience a subungual hematoma, it is important to treat it promptly to relieve pressure and pain. Drain the blood trapped under the nail by making a small hole in the nail with a needle. Do not make the hole over the nail bed laceration. If the hematoma covers more than half of the nail, seek medical attention as it may indicate a fracture or tissue tear.
Another type of nail bed injury is a laceration, which occurs when the nail and the underlying nail bed are cut. Lacerations can be treated with stitches, and the nail may need to be removed. If the nail is torn or jagged, trim it to prevent further injury.
In the case of a nail bed avulsion, where the nail and part of the nail bed pull away from the finger, the nail will likely need to be removed. This type of injury often occurs when the finger is jammed or stuck in something, and it commonly affects the ring finger. Avulsions can cause significant pain and swelling, and finger fractures are common.
Proper management of nail bed injuries is crucial to ensure good healing and prevent deformities. Keep the injured area clean and apply ice packs to reduce pain and swelling. If you have an artificial nail, leave it in place until the nail bed heals. Follow your doctor's instructions for wound care and keep your tetanus vaccination up to date.
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Home treatment for pain relief and to prevent infection
It is important to note that there is no cure for a nail that has separated from its nail bed—it cannot be reattached. However, treatment can keep new nail growth attached to the nail bed. If the nail bed separation is due to an injury, the detached part of the nail will eventually grow out. You can use nail clippers or nail scissors to remove the affected nail as it grows out.
If you have lost your nail, it will take about 7 to 10 days for the nail bed to heal. A new fingernail will take about 4 to 6 months to grow back, while toenails take about 12 months. The new nail will likely have grooves or ridges and be somewhat misshapen, which may be permanent.
- Apply ice wrapped in a cloth for 20 minutes every 2 hours on the first day, then 3 to 4 times a day after that.
- Keep your hand or foot above the level of your heart to reduce throbbing.
- Take over-the-counter pain relievers such as ibuprofen or naproxen to reduce pain and swelling. Acetaminophen can also help with pain, but not with swelling.
- If you have a broken bone in your finger or toe, your doctor may need to place a wire in your finger to keep the bone in place.
- Keep your nails trimmed short to prevent them from catching on objects and pulling further off the nail bed.
- Avoid biting your nails.
- Be careful when cleaning underneath your nails. Avoid using tools like cuticle sticks or nail brushes, as they can break the skin underneath your nails and cause infection.
- Avoid chemicals or products that can irritate your nails or the skin around them, such as nail polish, nail gloss, nail hardener, nail polish remover, and fake nails.
- Wear gloves when doing activities that may damage your nails, such as washing dishes, playing sports, or working outside.
- Wear clean socks and comfortable, protective shoes.
- Be careful when putting down heavy objects near your feet.
If your symptoms do not improve after a day or two of home remedies, or if you develop signs of infection (redness, swelling, pain, or pus), seek medical attention. Your doctor may prescribe antibiotics or perform minor procedures such as drainage to treat the infection.
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What to do after a nail procedure
Following a nail procedure, there are several steps you can take to ensure proper aftercare and healing. Firstly, it is important to keep the affected area elevated as much as possible to reduce pain and swelling. This can be done by propping up the injured hand or foot on a pillow when sitting or lying down. Take painkillers, such as paracetamol or ibuprofen, regularly for the first few days to manage any pain and discomfort.
If your doctor has prescribed antibiotics, be sure to finish the entire course as instructed, even if you start feeling better. If you notice increasing pain, swelling, or any unusual discharge from the wound, seek medical advice promptly. Keep the wound dressing dry and intact until your follow-up appointment, usually scheduled for one to two weeks after the procedure. During this time, it is crucial to avoid contact sports and activities that may expose the wound to sand or grit.
It is normal to experience some swelling, colour changes, and bloody crusting on or around the wound for the first few days. The wound should heal within a few weeks, and you can expect a new nail to start growing back within three months, although it may appear abnormal at first. Return to a normal-looking nail can take around nine months. To prevent stiffness in your fingers or toes, perform simple exercises: touch the tips of each finger with your thumb and move your wrist forward and backward. Keep your nails trimmed short to prevent them from catching on objects and causing further issues.
Finally, follow-up care is essential. Attend all scheduled appointments and reach out to your doctor if you have any concerns or experience problems with the nail as it grows back.
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