Ava Monroe
Fingernail and toenail disorders can cause sensitivity, pain, and embarrassment, and can even inhibit social relationships, employment, and daily activities. A dermatologist is a medical doctor who specializes in treating the skin, hair, and nails. They can perform nail surgery to treat nail fungus, tumors, or skin cancer underneath the nail. If a patient wants to have the nail plate removed for cosmetic reasons, or to try a different approach to eradicating a fungus, the doctor will perform a digital block to numb the finger or toe. After the digit is completely numb, the doctor will remove the nail entirely by lifting it off from the front. The patient will then be put on anti-fungal medications while the nail grows back, which can take 6-18 months.
| Characteristics | Values |
|---|---|
| Type of Doctor | Dermatologist, hand surgeon, plastic surgeon, orthopedic surgeon |
| Reasons for Surgery | Fungus, tumors, skin cancer, melanoma, nail biopsy, nail deformity, nail excision, infection, severe injury, ingrown toenail, nail problems caused by cancer treatment, indentation or ridges in the nails, breaking, cracking, or splitting of the nails, brown, black, or red lines, nail psoriasis, nail lichen planus, onycholysis, brittle nails, allergic reactions |
| Procedure | Local anesthesia, removal of some or all of the nail plate, application of antibiotic ointment and dressing, stitches, bandaging for 2-3 days, soaking the affected area in lukewarm water, applying ointment, monitoring for discoloration or redness |
| Recovery | Fingernails take 6-8 months to grow out, toenails take 8-18 months, normal activities can be inhibited during this time |
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What You'll Learn
Dermatologists perform nail surgery
Dermatologists are medical doctors who specialize in treating the skin, hair, and nails. They can diagnose and treat diseases and conditions of the skin, hair, nails, and mucus membranes. Dermatologists often perform specialized diagnostic procedures and surgical procedures, such as mole removal and skin biopsies. They also recognize symptoms that appear on the skin, hair, or nails, which may indicate problems inside the body, such as organ disease or failure.
Nail surgery is an integral part of dermatologic surgery, and dermatologists should be familiar with its diagnosis and therapeutic approach, which often involves surgical procedures. Dermatologists perform nail surgery to treat various conditions, including nail fungus, tumors, or skin cancer underneath the nail. They may also perform nail surgery to improve the appearance of the nail, such as in cases of nail deformity.
Before performing nail surgery, dermatologists will typically examine the nail and determine the appropriate treatment approach. This may involve taking a tissue sample for a biopsy or scraping debris from underneath the nail to diagnose a fungal infection. Once the issue is diagnosed, dermatologists can proceed with the necessary surgical techniques to treat the condition.
During nail surgery, the dermatologist will first numb the affected area with local anesthesia to ensure the patient's comfort. They may use a digital block numbing treatment, which involves injecting anesthesia near the affected nail to numb the entire finger or toe. This ensures that the patient does not experience any pain during the procedure.
After numbing the area, the dermatologist will perform the necessary surgical techniques to address the specific nail condition. This may involve removing some or all of the nail plate, treating infections, or addressing other nail problems. Following the surgery, the dermatologist will provide post-operative care instructions, including bandaging and medication if needed, to ensure proper healing.
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Nail surgery treats nail infections
Nail surgery is an effective treatment for nail infections, particularly those caused by fungus. Onychomycosis, or tinea unguium, is a common and contagious nail fungus caused by a type of mould called a dermatophyte. Toenail fungus is notoriously difficult to treat, and often returns even after successful treatment.
Nail avulsion is a type of nail surgery that involves removing some or all of the nail plate (the hard part of the nail). It can be performed under local anaesthesia, with a shot of medicine given near the affected nail to numb the area. Once numb, the surgeon will remove the infected nail and apply an antibiotic ointment and dressing. Post-operative oozing is normal, and a tight bandage is applied to the area for 2-3 days. The patient will need to keep the area dry and change the bandage after a set number of hours. Soaking the affected area in lukewarm water for 15 minutes can help to prevent the bandage from sticking to the wound.
In some cases, a nail biopsy may be necessary to check for problems underneath the nail, such as a tumour or skin cancer. During a nail biopsy, a small tissue sample is taken from the cuticle, nail plate, or nail matrix and sent for further evaluation. The area is numbed with a local anaesthetic to ensure the patient does not feel any pain during the procedure.
If a patient is experiencing nail fungus, a dermatologist will usually begin treatment with an oral or topical anti-fungal medication. If these treatments are ineffective, or if the patient is concerned about the thickness and appearance of the nail, nail surgery may be considered. This involves completely removing the nail plate and keeping the patient on anti-fungal medications while the nail grows back. Fingernails typically take 6-8 months to grow out, while toenails can take 8-18 months.
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Nail surgery can be used to treat cancer
The type of nail surgery performed depends on the type of cancer being treated. For example, melanoma under the nail may require Mohs surgery, an excision, or, in extreme cases, amputation of the toe. Surgical excision is also the primary treatment for cutaneous SCC, melanoma, and BCC skin cancers involving the nail unit. Digit-sparing surgery is often recommended for these malignancies, but amputation may be performed if preservation of the digit is not desired or possible.
Nail avulsion is a procedure that removes some or all of the nail plate and can be used to treat cancer-related nail problems, such as redness, swelling, oozing, pain, infection, or odour. This procedure can also be used to treat nail fungus, which can be a precursor to cancer. If there is a large lesion on the nail, there may be some deformity when the nail grows back.
Cancer treatment can cause various side effects that affect the nails, such as horizontal ridges (Beau's lines), nails lifting from the nail bed, or nails coming off completely. These side effects are usually short-term, and nails typically grow back healthy after treatment. However, in some cases, the nail may grow back thick and painful, requiring further treatment.
It is important to note that nail surgery may not always be the first course of action for treating cancer. In some cases, cancer-related nail problems can be managed with topical drugs, therapeutic creams, or ointments. Additionally, patients are advised to take precautionary measures to avoid infection during cancer treatment, such as avoiding manicures or pedicures and soaking nails in a vinegar and water solution.
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Nail surgery can be used to treat nail injuries
In some cases, a nail avulsion may be performed to remove some or all of the nail plate, which is the hard part of the nail. This procedure can be done to treat severe nail injuries, infections, or ingrown toenails. It can also be used to remove the skin below the nail plate. A nail avulsion is often recommended when other treatments have failed to resolve the issue.
For more complex injuries, such as subungual hematoma, wounds, lacerations, or avulsions of the nail bed, surgical repair may be necessary. This may involve the use of flaps or grafts to reconstruct the nail bed and restore its function and appearance. The specific technique will depend on the patient's anatomy and the extent of the injury.
It is important to note that the recovery process after nail surgery can take some time. Fingernails can take about 6 months to regrow, while toenails can take up to a year. Proper wound care and follow-up with a healthcare provider are crucial to ensure optimal healing and reduce the risk of complications.
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Nail surgery can be used to treat nail deformities
One type of nail deformity is a pincer nail, where the nail bed becomes compressed, causing an overcurvature of the nail. This can be corrected through nail plate and bed reconstruction surgery, which is a simple and quick procedure that reduces the risk of complications compared to other techniques. During this procedure, the nail plate is detached, and the nail fold is pushed underneath before being fixed in place. This technique helps to increase the width of the nail tip and decrease its height, improving the appearance and reducing pain during walking or exercising.
Another type of nail deformity is a hook nail, which occurs when the nail bed becomes longer than the underlying bone due to a fingertip injury. This can be corrected by providing more support to the nail bed or shortening it to match the length of the bone. In some cases, a nail avulsion procedure may be recommended, which involves removing some or all of the nail plate and, if necessary, the skin below it. This can be done to treat infections, remove growths, or address injuries to the nail.
Nail surgery is often performed by a dermatologist, who can diagnose and treat various nail conditions. Before any procedure, the area around the nail is numbed using local anaesthesia, and a nerve block may be placed in the finger or toe to provide additional pain relief. After the surgery, it is important to keep the area clean and dry, following the instructions provided by the healthcare provider to ensure proper healing.
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Frequently asked questions
Fingernail surgery is usually performed by a board-certified dermatologist.
Fingernail surgery can be used to treat nail fungus, tumors, or skin cancer underneath the nail. It can also be done to treat nail problems caused by cancer treatment, such as redness, swelling, oozing, pain, infection, or odor.
During fingernail surgery, the doctor will remove some or all of the nail plate, which is the hard part of the nail. The patient will be given local anesthesia to numb the area before the procedure. After the nail is removed, the doctor will apply an antibiotic ointment and dressing to the wound.
It typically takes about 6 months for a fingernail to regrow after surgery.
You should see a dermatologist if you notice any changes in the color, texture, or shape of your fingernails. Other signs that may indicate a need for medical evaluation include pits or dents in the nails, spoon-shaped nails, nail lifting, redness and swelling around the nail, and thick, overgrown nails.
