Nail removal
Nail removal is a medical procedure that involves either the complete removal of a nail, known as nail avulsion, or the partial removal of a nail, referred to as a matrixectomy. This procedure is commonly performed in primary care settings, particularly for toenails, but can also apply to fingernails. Indications for nail removal include infections, ingrown nails, or trauma, often resulting in discomfort and functional difficulties for the patient. The procedure typically requires local anesthesia administered to numb the affected digit, and sterile techniques are employed throughout.
During the procedure, the nail is carefully separated from the nail bed; in complete removals, the nail is gently pulled away, while in partial removals, only a portion is cut away. Post-procedure care is crucial to prevent complications such as pain, bleeding, or infection. While nail removal can relieve certain conditions, it may not cure fungal infections on its own. Additionally, patients should be informed that the nail may not regrow in the same shape, and proper nail care practices should be followed to avoid recurrence of issues like ingrown nails. Overall, nail removal is a relatively quick procedure and allows patients to resume normal activities soon after.
Nail removal
Anatomy or system affected: Feet, hands, nails
Definition: The partial or total removal of either fingernails or toenails
Indications and Procedures
Nail removal is a common office procedure seen in primary care. A full removal is called a nail avulsion, while a partial nail removal is called a matrixectomy. Nail disorders leading to removal occur most often in toenails, but they can also occur in fingernails. Common reasons for removal are infection, ingrown nails, or trauma. Patients usually experience pain and inability to function in their normal activities. Rarely are there any systemic signs or symptoms, such as fever, chills, or nausea, unless the cause is a serious infection.
The patient’s foot or hand is first cleansed and draped. Sterile techniques are used throughout the procedure. Patients undergoing partial or total nail removal require adequate anesthesia, which is usually done through a digital block. This procedure is performed at the base of the digit with lidocaine or a similar anesthetic to numb the entire finger or toe. The provider should wait five minutes for the anesthesia to become effective. A tourniquet may be applied to minimize bleeding and enhance anesthesia. An instrument is then used to separate the nail from the nail bed with the least trauma possible. In a complete removal, the nail is gently pulled away from the nail bed. In a partial removal, scissors are used to cut the desired amount of nail away from the intact nail. Some providers will also chemically destroy the nail matrix in the area of the partial removal to prevent recurrent ingrown nails if clinically indicated.
Compression for a few minutes may be needed to slow any bleeding from the nail removal. Topical antibiotic ointment may be applied with gauze and a compression dressing. When a toenail is removed, patients may walk immediately after the procedure and resume any activity as tolerated. Local wound care instructions are given, and if the procedure is performed secondary to an infected digit, oral antibiotics may be ordered. The procedure usually takes approximately fifteen minutes to complete.
Uses and Complications
Partial nail removal or trimming may also be performed in diabetic patients or those unable to perform routine nail care, such as the elderly or those suffering from chronic illness. Fungal infections cannot be cured with nail removal alone, though in severe or painful cases, the procedure may be performed in conjunction with the administration of antifungal agents.
Nail removal has few complications if performed properly. Pain is one of the most common complications of the procedure, especially if the digit was already infected. Bacterial infection may also occur after the procedure without proper wound care management. Bleeding may occur, as epinephrine is not used in digital blocks. Adequate compression or cautery usually stops any continued bleeding after the procedure. Patients must also be warned that the nail may not grow back with the same shape before removal. Nails should be cut straight across without curvature to prevent any ingrown nail recurrence.
Bibliography
Clark, Robert E., and Whitney D. Tope. “Nail Surgery.” In Cutaneous Surgery, edited by Roland G. Wheeland. Philadelphia: W. B. Saunders, 1994.
“Nail Diseases.” MedlinePlus, April 11, 2013.
“Surgical Nail Removal for Fungal Nail Infections.” Kaiser Permanente, 2023, healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.surgical-nail-removal-for-fungal-nail-infections.hw268840. Accessed 21 July 2023.
Woods, Michael, et al. “Ingrown Toenail Removal.” Health Library, May 2, 2013.
Zuber, Thomas J. “Ingrown Toenail Removal.” American Family Physician 65, no. 12 (June 15, 2002): 2547–2554.