Nail avulsion is the medical term for the partial or total removal of a fingernail or toenail from its underlying nail bed. This procedure is necessary following trauma, chronic infection, or other conditions that compromise the nail unit’s health. Since the nail plate protects the sensitive nail bed and the matrix responsible for new growth, removal carries risks like infection or permanent deformity. Attempting to remove a firmly attached or severely injured nail at home is strongly discouraged, as safe management requires a sterile, professional environment.
When Professional Removal is Necessary
Certain nail conditions demand immediate attention from a podiatrist, dermatologist, or emergency room physician. Any severe crush injury to the finger or toe, especially one causing significant bleeding under the nail (subungual hematoma), requires medical evaluation. This trauma may signal damage to the nail bed tissue or an underlying fracture that needs repair to ensure correct nail regrowth.
Signs of deep infection around the nail also require prompt medical intervention to prevent bacterial spread. Indicators include rapidly spreading redness or swelling, pus or foul-smelling discharge, or systemic symptoms like a fever. An ingrown nail (onychocryptosis) that has deeply penetrated the skin or caused chronic, painful inflammation often requires partial surgical removal if conservative treatments fail.
Chronic conditions, such as severe fungal infection (onychomycosis), often resist topical or oral medications alone. If the infection results in a dense mass of fungus (dermatophytoma), mechanical or chemical avulsion is sometimes performed. This removes the diseased nail plate and allows antifungal agents to reach the infected nail bed. Permanent nail removal, or matricectomy, may be considered for persistently painful or recurrently infected nails that are severely deformed, such as with onychogryphosis.
First Aid for Partially Detached Nails
If a nail is partially torn or loose following a minor injury, home management is appropriate only if there are no signs of deep trauma, excessive bleeding, or infection. The goal of first aid is to prevent the loose fragment from catching on objects, which could cause further damage to the nail bed. Never attempt to forcibly rip off any part of the nail that is still securely attached, as this causes unnecessary pain and injury.
The loose portion of the nail should be carefully trimmed along the line of the tear using clean, sterilized nail scissors or clippers. Once removed, gently clean the exposed nail bed and surrounding skin with mild soap and water to clear debris. Since the exposed nail bed is sensitive and prone to infection, apply an antibiotic ointment or petroleum jelly.
The area must be covered with a sterile, non-stick bandage to protect the tissue until the skin hardens, which takes seven to ten days. Change the dressing at least once a day, or immediately if it becomes wet or soiled, to maintain a clean environment. If bleeding does not stop quickly with gentle pressure, or if you notice increasing pain, redness, or swelling, seek a medical evaluation immediately.
The Medical Procedure for Complete Nail Removal
A medical professional, such as a podiatrist or dermatologist, performs a complete nail avulsion under sterile, outpatient conditions. The first step involves anesthetizing the digit using a digital nerve block, where a local anesthetic like lidocaine is injected at the base of the finger or toe. A tourniquet is often applied to the digit to control blood flow and ensure a clear surgical field during the procedure.
The surgeon uses specialized instruments, such as a nail elevator or Freer elevator, to gently separate the nail plate from the underlying nail bed and the proximal nail fold. This instrument is advanced beneath the nail until it reaches the matrix (the root of the nail). Once completely separated, the nail plate is grasped with a hemostat (a clamp-like tool) and removed using steady traction.
If the nail is being removed to treat a chronic problem like an ingrown toenail, a partial avulsion may be performed, removing only the problematic sliver of nail. If the goal is permanent removal to prevent recurrence, a chemical agent like phenol or electrocautery is used on the exposed nail matrix. This process, called matricectomy, destroys the tissue that produces the nail. The entire procedure is quick, lasting only a few minutes once the area is numb.
Post-Removal Care and Healing
Immediate aftercare focuses on protecting the exposed nail bed and managing discomfort. The surgeon applies a bulky, sterile dressing that must be kept clean and dry for the first 24 to 48 hours to minimize bacterial contamination. Keeping the hand or foot elevated above heart level and applying ice during the first two days reduces post-procedure swelling and throbbing pain.
Pain management involves over-the-counter medications like ibuprofen or acetaminophen, though prescription medication may be provided for more involved procedures. Dressing changes must follow the specific instructions provided by the medical team. This usually involves daily or every-other-day replacement of the non-stick bandage and reapplication of petroleum jelly or antibiotic ointment. If the bandage sticks to the wound, soaking the digit in warm water for a few minutes will loosen it without damaging the healing tissue.
The healing process involves a lengthy timeline for new nail growth. It takes approximately six months for a fingernail and twelve to eighteen months for a toenail to fully regrow. During this period, activities like swimming or strenuous exercise should be restricted for several weeks to allow the nail bed to heal. Patients who underwent a chemical matricectomy may notice a yellowish-green discharge in the first week, which is a normal result of the chemical application.
Monitoring for signs of a secondary infection is important, including increasing redness or tenderness, warmth around the wound, or the development of a fever. The newly exposed nail bed forms a protective layer of hardened skin within a few weeks. However, the area remains vulnerable until the new nail fully covers it. Wearing open-toed shoes or loose-fitting footwear is necessary for several weeks to prevent pressure on the sensitive area.