With increasing use of nail paints, nail art, acetone, repeated manicures, cosmetic nail procedures and detergents the nail plate undergoes repeated damage resulting in rough lusterless and pigmented nails. Besides that fungal infection of nails, lichen planus infecting nails, nail pitting and ridging due to various diseases also cause cosmetically disfiguring nails. Chemical peels for the nails could result in shinier, smoother and brighter nails making them cosmetically pleasing.
When to Consider Nail Clinic
Fungal nail infection is a common foot infection causing yellow, thick, scaly and foul smelling nails. Fungus can be picked up anywhere and it has a tendency to spread quickly. Considering that the infection is mostly in the nail bed underneath the nail plate, it is typically hard to get rid of this infection. Up until now, the only treatment choices consisted of oral and topical medications.
With increasing use of nail paints, nail art, acetone, repeated manicures, cosmetic nail procedures and detergents the nail plate undergoes repeated damage resulting in rough lusterless and pigmented nails.
Detailed Procedural Information
How is a Nail Clinic procedure performed?
Nail avulsion is the most common surgical procedure performed on the nail unit. It is the excision of the body of the nail plate from its primary attachments, the nail bed ventrally and the PNF dorsally. Avulsion of the nail plate may be initially performed to allow full exposure of the nail matrix before chemical or surgical matricectomy. Other indications for performing nail avulsion are to treat recalcitrant onychocryptosis; to excise tumors of the nail unit; to allow full examination and exploration of the nail bed, the nail matrix, the PNF and the LNF, and the nail grooves for the presence of pathology; or to use as a preliminary step before performing biopsy on the nail bed and the nail matrix.
Avulsion of the nail plate is frequently used as a therapeutic adjunct in long-standing fungal infections of the nail, such as chronic onychomycosis, and in acute bacterial infections. In traumatic nail injuries, avulsion may be used to evaluate the stability of the nail bed or to release a subungual hematoma after failed puncture aspiration.
Before avulsion, anesthesia of the digit is achieved through a digital block performed with 1% lidocaine. A Penrose drain secured with a hemostat clamp is used for hemostasis. Any of the following 3 blunted instruments may be used to separate the nail plate from its attachments: the mosquito hemostat, the Freer septum elevator, or the dental spatula. In distal nail avulsion, the instrument is introduced under the distal free edge of the nail plate to separate the nail plate from the underlying nail bed hyponychium on its ventral surface. All attempts at separation are directed proximally toward the matrix, with significant resistance occurring until the matrix is reached. When the matrix is contacted, the surgeon usually experiences less resistance and might feel a laxity because of a weaker attachment. After reaching the matrix, the elevator is reinserted with several longitudinal forward and backward strokes performed side by side until the nail bed is completely freed from the overlying nail plate.
What are my options?
The two primary methods for performing nail avulsion are distal avulsion and proximal avulsion. A third method, chemical avulsion with urea paste, is a nonsurgical avulsion technique that may be performed. A partial or complete nail avulsion can be performed, depending on location and extent of disease. Surgical nail avulsion is not a definitive cure in cases of nail dystrophy caused by onychocryptosis, nail matrix disease, or extensive nail bed pathology (eg, SCC).
Preparing for Your Procedure
How do I prepare for a Nail Clinic procedure?
This procedure is done in a clinical setting under local anesthetic with a minimal down time. Surgical complications with this procedure are not common as long as the post surgical advice is followed and the area is kept clean.
In advance of your procedure, your surgeon will ask you to:
- Please remove all traces of nail varnish
- Do not drink any alcohol.
- Eat a normal light meal before the surgery.
- Bring suitable footwear that will fit over a bulky dressing.
Aftercare and Recovery
Our surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your postsurgical care, including information about:
- The toe may remain numb for up to 4 hours.You should rest the affected foot as much as possible especially in the first 24-48 hours..
- Take your normal painkillers to reduce any discomfort if needed and follow the instructions on this leaflet.
It is vitally important that you follow all patient care instructions provided by your surgeon. This will include information about wearing compression garments, taking an antibiotic if prescribed and the level and type of activity that is safe. Immediately after surgery your hands will be bruised, swollen, and stiff. Immediately after surgery your hands will be bruised, swollen, and stiff.