Liam Carter
The removal of a fingernail is called a nail avulsion, a medical procedure that involves removing some or all of the nail plate (the hard part of the nail). This procedure is often carried out to treat nail problems, such as infections, injuries, or ingrown toenails, that have not responded to other treatments. Prior to the procedure, local anaesthesia is administered to numb the affected area, and a tourniquet may be applied at the base of the finger to minimise bleeding. Following the procedure, an antibiotic ointment and dressing are applied to the wound, and the patient may be prescribed antibiotics to take at home.
| Characteristics | Values |
|---|---|
| Procedure Name | Nail Avulsion or Nail Removal |
| Procedure | Removes some or all of the nail plate (the hard part of the nail) |
| Anesthesia | Local anesthesia or general anesthesia |
| Post-Procedure Care | Antibiotic ointment and dressing (bandage) on the wound; may also be prescribed antibiotics to take at home |
| Healing Time | 5-7 days for the wound; 6 months for fingernails to regrow; 1 year for toenails to regrow |
| Symptoms After Procedure | Throbbing, pain, swelling, bleeding, discharge, or sensitivity in the affected area |
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What You'll Learn
Nail avulsion
During nail avulsion, local anaesthesia is administered to numb the affected area. Once the anaesthesia takes effect, the healthcare provider uses a hemostat to secure a tourniquet at the base of the finger or toe to control bleeding. Then, they gently separate and remove the nail plate, taking care to avoid damaging the nail bed and the overlying nail fold.
After the procedure, the provider applies an antibiotic ointment and dresses the wound with a bandage. Patients are typically prescribed antibiotics to take at home and are instructed to keep the bandage dry for a specified period before changing it. It is common to experience symptoms such as throbbing, pain, swelling, bleeding, discharge, or sensitivity in the affected area after the procedure.
The regrowth process for fingernails typically takes about six months, while toenails can take up to a year or more. The new nail often appears normal, but injured nails may exhibit differences upon regrowth. Follow-up care is crucial to ensure proper healing and address any concerns.
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Anaesthesia and pain management
The removal of a fingernail or toenail is called a nail avulsion. It is a minor surgical procedure that can be carried out safely under local ring block anaesthesia, although some patients may opt for general anaesthesia. Anaesthesia is crucial for nail surgery to be painless and safe, and the choice of anaesthetic is important. The surgeon must select the appropriate type of anaesthesia according to the patient's age, surgical indication, and comorbidities.
Local anaesthesia is commonly used for nail avulsion, where injections are given close to the affected nail or at the base of the finger or toe to numb the area. Lidocaine is typically used, with the dose adapted to the size of the digit and the patient's age. It is important to note that the injection site may be painful, and it takes a few minutes for anaesthesia to set in before surgery. Once the anaesthetic takes effect, the patient will not feel any pain during the procedure.
In some cases, distal anaesthesia or ropivacaine may be used for long and/or painful procedures. Additionally, a nerve block may be placed in the finger or toe to provide extended pain relief. A tourniquet may also be applied to the base of the finger or toe to minimise bleeding during the surgery.
After the procedure, patients may experience pain when the local anaesthetic wears off. It is recommended to take painkillers regularly to manage this pain, following the instructions provided with the medication. Patients should also be aware of potential side effects, such as throbbing, swelling, bleeding, discharge, or sensitivity in the affected area. If these symptoms persist or become concerning, it is important to contact the healthcare provider for further advice.
Overall, anaesthesia and pain management are crucial aspects of nail avulsion surgery, ensuring patient comfort and safety throughout the procedure and during the recovery process.
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Post-removal care
The removal of a fingernail or toenail is called avulsion. This procedure is often carried out to treat nail problems such as infections, injuries, ingrown toenails, or nail problems caused by cancer treatment.
- Your doctor may have put part of the nail back into place or repaired the nail bed. Your toe or finger may be sore after treatment, and you may have stitches.
- It is normal to experience swelling, colour changes, and bloody crusting on or around the wound for 2-3 days.
- Take good care of your wound to help it heal quickly and reduce the chance of infection. The wound should heal within a few weeks, and you can expect the nail to regrow in about 6 months for fingernails and 12-18 months for toenails.
- Keep the wound dry and follow the instructions for changing your bandage. Soak the affected area in lukewarm water for 15 minutes to prevent the bandage from sticking to the wound.
- Gently remove the bandage, wash the wound with soap and water, and pat it dry with clean gauze.
- Check for blue, purple discolouration, or redness. If you notice any discolouration or redness, contact your healthcare provider.
- Apply ointment to the wound and cover it with a new bandage. Keep the tip of your finger or toe exposed so you can continue checking for discolouration or redness.
- Change the bandage once or twice a day until the wound is healed, which usually takes 5-7 days.
- You may experience throbbing, pain, swelling, bleeding, discharge, or sensitivity in the affected area after the procedure. If you experience bleeding, apply pressure with a clean gauze pad for 15 minutes. If the bleeding does not stop, apply pressure for another 15 minutes. If it still does not stop, contact your healthcare provider.
- Take pain medication as directed. Do not take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or naproxen (Aleve) unless advised by your healthcare provider, as these can increase bleeding.
- If you have been prescribed antibiotics, take the full course as directed. Do not stop taking them just because you start feeling better.
- Contact your doctor if you notice any of the following: increased pain, swelling, warmth, or redness; red streaks leading from your toe or finger; pus draining from your toe or finger; swollen lymph nodes in your neck, armpits, or groin; or any problems with the nail as it grows back.
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Nail separation (onycholysis)
Nail avulsion is a procedure on your finger or toe that removes some or all of your nail plate (the hard part of your nail).
Onycholysis, or nail separation, is a common nail disorder in which the nail separates from the nail bed. It is often painless and appears as a well-defined area of white opaque nail. It may be idiopathic or secondary to trauma, skin disease, nail infections, tumours, or systemic events. Onycholysis can affect a single nail or multiple fingernails and/or toenails, and it usually lasts for several months.
The most important step in treating onycholysis is to determine its cause. Once the cause is found, treating the underlying issue will help resolve the condition. For example, if onycholysis is caused by a fungal infection, applying a mixture of tea tree oil diluted with a carrier oil, such as jojoba or coconut oil, can help get rid of the fungus. It is important to keep the nail dry while it heals and to avoid creating a moist environment that bacteria can grow in.
In some cases, onycholysis may be a symptom of an underlying condition such as psoriasis, thyroid disease, vitamin deficiency, or iron deficiency. A blood test may be necessary to determine if there is an underlying condition causing the onycholysis. Doctors may prescribe medication or supplements to treat the underlying cause.
The goal of treatment for onycholysis is to help a new nail grow and remain attached to the nail bed. This involves keeping the nails short and trimmed, avoiding activities that may harm the nails, and minimising trauma to the nail and nail bed. It is also important to avoid potential irritants such as nail enamel, enamel remover, solvents, and detergents.
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Surgical alternatives
The removal of a fingernail is called a nail avulsion. This procedure can be carried out under local ring block anaesthesia, although some patients may opt for general anaesthesia. Local anaesthesia is administered by injection close to the affected nail, and a tourniquet is applied at the base of the finger to minimise bleeding. Once the anaesthesia has taken effect, the nail is gently removed with a hemostat, taking care not to damage the nail bed or overlying nail fold. After the nail is removed, the wound is dressed, and antibiotics may be prescribed to prevent infection.
There are several surgical alternatives to nail avulsion, depending on the specific condition being treated. Here are some examples:
Chemical Avulsion
For conditions such as onychomycosis, a chemical avulsion may be considered instead of surgical nail removal. This involves the weekly application of 40% urea and 1% bifonazole, which can lead to earlier nail removal.
Nail Fold Surgery
Proximal nail fold surgery is performed for the diagnosis and/or treatment of nail fold or subungual neoplasms, chronic paronychia, or post-traumatic reconstruction. The proximal nail fold can regenerate to a certain extent after surgical removal, reforming a functional barrier.
Lateral Nail Fold Biopsy
For a lateral nail fold biopsy, an incision is made longitudinally along the lateral nail fold. After the affected nail fold is removed, the surgical incision is closed. This technique may be used for the diagnosis of onychomycosis or other nail dermatoses.
Cross-Finger Flap
The cross-finger flap technique is used for the reconstruction of larger and more complicated defects or in situations where skin grafts are contraindicated. It involves removing the entire nail apparatus and creating a "U"-shaped flap from an adjacent digit, which is then sutured in place.
Skin Grafts
For larger defects, full-thickness skin grafts may be used. Melanoma of the nail apparatus, for example, may be treated with excision of the entire nail organ, followed by repair with a skin graft.
These surgical alternatives to nail avulsion are performed by experienced hand and nail surgeons, taking into account the specific condition being treated and the individual patient's needs.
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Frequently asked questions
Fingernail removal is called a nail avulsion.
A local anaesthetic is administered to numb the affected area. A tourniquet may be applied to the base of the finger to minimise bleeding. The nail is then gently removed by applying firm and steady distal traction using a hemostat.
An antibiotic ointment and dressing are applied to the wound. The patient may be prescribed antibiotics to take at home. It is important to keep the wound dry and change the bandage after a certain period.
It typically takes about 6 months for a fingernail to regrow, and the new nail often looks normal.
As with any procedure, there are potential risks and complications. These may include bleeding, pain, swelling, infection, and sensitivity in the affected finger. It is important to follow the care instructions provided by your healthcare provider to promote proper healing and reduce the risk of complications.
