Caleb Foster
The nail plate is the hard part of the nail. Nail avulsion is a procedure that removes some or all of the nail plate, and possibly the skin beneath it. It is performed to treat nail problems that have not improved with other treatments, such as infection, injury, growths, and ingrown toenails. The procedure can be done surgically or chemically, and typically involves numbing the area, removing the nail, and applying an antibiotic ointment and dressing. It can take several weeks for the nail to be completely removed, and nail regrowth can take up to 18 months.
| Characteristics | Values |
|---|---|
| Definition | Removal of some or all of the nail plate (the hard part of the nail) |
| Procedure | Nails are washed with surgical soap or alcohol. A tourniquet may be applied at the base of the finger to minimize bleeding. Curved Iris scissors, a scalpel blade, or a nail splitter/elevator is used to separate the nail plate from the nail bed. The nail is then removed by applying firm and steady distal traction using a hemostat. |
| Purpose | To treat nail problems that have not responded to other treatments, such as infection, injury, growths, or ingrown toenails. It is also used for diagnostic purposes, such as performing a biopsy on the nail bed. |
| Recovery | It takes around 6 months for a fingernail to regrow and about 1 year for a toenail. The new nail usually looks normal. |
| Complications | Pain, swelling, bleeding, discharge, and sensitivity in the affected area. Prolonged pain and morbidity are possible, especially with total nail plate removal. |
| Alternatives | Conservative management for stage 1 ingrown toenails includes warm soaks, cotton-wick elevation, and antibiotic therapy. For fungal nail infections, oral and topical antifungal medications are used. |
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What You'll Learn
Medical nail avulsion
Prior to the procedure, the affected area is cleaned with surgical soap or alcohol. Local anaesthesia is administered to numb the area, and a nerve block may be placed in the finger or toe to provide extended pain relief. Once the area is numb, the healthcare provider will gently separate and remove the nail using curved Iris scissors or a small periosteal elevator, taking care to avoid damaging the nail bed or overlying nail fold.
After nail removal, 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 in place for the instructed amount of time before changing it. Patients can expect the affected area to remain numb for 1-2 hours due to the local anaesthesia. If the procedure was performed on a toe, it is advisable to avoid wearing tight clothing for about 1-2 weeks to prevent accidental removal of the bandage.
The regrowth process typically takes around 6 months for a fingernail and up to 1 year for a toenail. During this time, it is essential to properly care for the wound to ensure healing and monitor for any signs of infection or other complications. Patients may experience symptoms such as throbbing, pain, swelling, bleeding, discharge, or sensitivity in the affected area. Soaking the finger or toe in lukewarm water and regularly changing the bandage according to the provided instructions can aid in the healing process.
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Nail deformities
- Onycholysis: This occurs when the nail separates from the nail bed, causing a white discoloration. Onycholysis can be due to infection, trauma, or products used on the nails, such as nail polish, nail gloss, nail hardener, nail polish remover, and fake nails. It can also be caused by fungal infections, which cause the nails to become thick and yellow, with white spots and streaks.
- Leukonychia: This is characterized by non-uniform white spots or lines on the nail, usually resulting from minor trauma and is harmless in healthy individuals. However, it can sometimes be associated with poor health or nutritional deficiencies.
- Koilonychia: This condition is characterized by nails that are flattened and have concavities, or scoop outward like spoons. It is often associated with iron deficiency.
- Yellow nail syndrome: This rare condition is characterized by slow-growing, thickened, hypercurved, yellow nails that lack a cuticle and may be loose or detached. It is most commonly associated with lung disorders and lymphedema.
- Nail psoriasis: This condition causes changes to the structure of the nails, including onycholysis.
- Nail-patella syndrome: This syndrome causes triangular lunulae and partially absent thumbnails.
- Paronychia: This is an infection around the nailfold and cuticle that can be caused by various organisms, including the yeast-like organism Candida.
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Onycholysis
The most common cause of onycholysis is trauma or injury. Even slight trauma, such as daily tapping on a keyboard or counter, can cause onycholysis when it occurs repetitively. Manicure tools pushed beneath the nail and excessive moisture can also cause the problem. Certain chemicals in nail products like nail polish, nail gloss, nail hardeners, and fake nails can irritate the nails and cause onycholysis.
Fungal infections are another common cause of onycholysis. These infections cause nails to become thick and yellow, with white spots and streaks. Oral and topical antifungal medications are often used to treat fungal infections. However, it is important to complete the full course of medication to prevent the fungus from returning and becoming harder to treat.
Other causes of onycholysis include skin conditions such as psoriasis, allergic reactions, and medical conditions like hyperthyroidism and iron deficiency. Chemotherapy and certain medications can also cause onycholysis by inducing light sensitivity.
The treatment for onycholysis depends on the underlying cause. In some cases, cutting away the separated nail as it grows out may be sufficient. Keeping the nail dry and avoiding further trauma can help the nail to reattach. However, if the condition persists and the nail continues to detach, the nail bed may form a granular layer of abnormal cells. In such cases, oral antifungal medications or other treatments targeting the specific cause may be necessary.
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Ingrown toenail removal
An ingrown toenail occurs when the toenail grows into the skin, which can cause infection and pain. Ingrown toenails are typically treated by partially removing the nail. For a more severe case (characterised by inflamed skin, pain and pus), a healthcare provider may numb the toe and trim or remove the ingrown portion of the nail. This procedure can take 2 to 4 months for the toenail to grow back.
If the ingrown toenail is a recurring problem, a healthcare provider may suggest removing a portion of the nail along with the underlying tissue (nail bed). This procedure may prevent that part of the nail from growing back. The toe will be numbed, and a chemical, laser, or other methods may be used. Ingrown toenail treatment may include placing cotton, dental floss, or a splint under the edge of the nail to separate the nail from the overlying skin. This helps the nail grow above the skin edge.
There are several techniques that may be used to treat ingrown toenails:
- Nail avulsion: Removing the whole toenail.
- Wedge excision: Removing the part of the toenail growing into the skin, along with the area of tissue in the corner that the toenail grows from.
- Nail-bed ablation: Removing part or all of the toenail and then applying a chemical (usually phenol) to the area of tissue that the toenail grows from.
- Zadek's procedure: Removing the whole toenail and then cutting away the area of tissue that the toenail grows from.
After an ingrown toenail removal procedure, a patient can take a pain reliever as needed. It might help to apply a wet compress for a few minutes for a few days, until the swelling has gone down. It is normal for the affected area to feel numb for 1 to 2 hours after the procedure due to the local anaesthesia. If the procedure was performed on a toe, avoid wearing tight clothing for about 1 to 2 weeks afterward.
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Nail bed biopsy
A nail avulsion or nail removal is a procedure to remove some or all of the nail plate (the hard part of the nail). It can also remove the skin below the nail plate. Nail removal may be recommended to treat nail problems such as infections, injuries, ingrown toenails, or nail problems caused by cancer treatment.
A nail biopsy is a procedure to take a sample of tissue from the skin under the nail. It may be done to check for abnormal cells. There are several types of nail biopsies, including nail plate, nail bed, nail fold, and nail matrix biopsies. The type of biopsy performed depends on the underlying diagnosis.
A nail bed biopsy is performed to diagnose skin lesions and rashes isolated under the nail plate. The nail is commonly avulsed before the biopsy. This involves inserting a nail elevator under the proximal nail fold to loosen the nail plate from the overlying nail fold. The elevator is then inserted under the distal nail plate and pushed proximally to detach the nail plate from the nail bed. After avulsion, the specimen is removed with an excisional biopsy taken longitudinally or via a punch biopsy tool.
Nail bed biopsies are considered more complex than nail plate biopsies and carry a higher risk of scarring. It is important to follow the doctor's instructions for caring for the wound after the procedure, including keeping the area clean and dry and changing the bandage as instructed. It is normal for the affected area to feel numb for 1-2 hours after the procedure due to local anesthesia. It takes about 6 months for a fingernail to regrow and about 1 year for a toenail to regrow.
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Frequently asked questions
Nail plate removal, or nail avulsion, is a procedure to remove some or all of the nail plate (the hard part of the nail).
Nail deformities that require nail removal can occur due to injury, infection, self-mutilation, or a tumour. It can also be done to treat an ingrown toenail or to treat nail problems caused by cancer treatment.
The affected area is cleaned and numbed. Then, curved scissors or a scalpel blade is inserted beneath the nail to separate it from the nail bed. Once separated, the nail is gently removed. An antibiotic ointment and dressing are then applied to the wound.
It takes about 6 months for a fingernail to regrow and about 1 year for a toenail to regrow.
Yes, in some cases, nail separation (onycholysis) can be treated by cutting away the separated nail as it grows out. Topical or oral antifungal medications may also be prescribed if the issue is caused by a fungal infection.
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