A nail avulsion is a minor surgical procedure performed to remove the nail plate, which is the hard part of the nail, from its underlying nail bed. This detachment can be executed on either a fingernail or a toenail when a medical condition necessitates it. The procedure is broadly categorized into two types: a partial avulsion and a total avulsion. A partial avulsion involves removing only a specific segment of the nail, often the problematic side edge, while a total avulsion requires the complete removal of the entire nail plate.
Reasons for Performing Nail Avulsion
The procedure is commonly recommended when less invasive treatments have failed to resolve a persistent issue affecting the nail unit. A primary reason for performing a nail avulsion is to treat chronic ingrown toenails (onychocryptosis), especially when the surrounding skin is inflamed or infected. Removing the nail section allows the inflamed tissue to heal and relieves pressure from the nail plate.
Nail removal is also necessary for severe fungal infections (onychomycosis) that have not responded to oral antifungal medications. In cases of acute nail trauma, a total avulsion may be performed to repair the nail bed or to drain a subungual hematoma (a large collection of blood beneath the nail). Chronic nail deformities, such as a pincer nail, which curves inward, may also require total avulsion.
The Procedure Steps
The process begins with a local anesthetic, typically a digital nerve block, which numbs the entire finger or toe. Once the digit is numb, a small rubber tourniquet is often applied to the base of the digit to create a bloodless field, improving visibility for the physician. After the area is sterilized, a specialized instrument, such as a nail elevator, is carefully inserted under the edge of the nail plate.
For a partial avulsion, the instrument separates the problematic section of the nail from the nail bed, and a vertical cut isolates the segment before removal. A total avulsion involves separating the entire nail plate from the underlying tissue, moving from the distal edge toward the proximal matrix. If the goal is to permanently prevent nail regrowth, a chemical matrixectomy is performed immediately afterward. This involves applying a chemical agent, most commonly 88% phenol, to the nail matrix—the tissue where the nail originates—to destroy the cells responsible for growth. The phenol is applied for several cycles and then neutralized with an agent like isopropyl alcohol before the site is dressed.
Post-Procedure Recovery and Aftercare
Recovery from a nail avulsion requires careful attention to reduce swelling and promote healing of the exposed nail bed. For the first 24 to 48 hours following the procedure, the affected hand or foot should be elevated above the level of the heart to minimize throbbing pain and swelling. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, are usually sufficient to manage the discomfort once the local anesthetic wears off.
The initial bulky dressing applied by the physician should remain intact and dry for the first one to two days to protect the wound and allow clotting to occur. After this period, the patient removes the dressing and begins gentle wound care. This involves washing the area with mild soap and water once or twice daily. Soaking the digit in a warm water or Epsom salt solution for five to ten minutes can help clean the area and prevent the new dressing from sticking.
Following cleansing, the exposed area should be blotted dry and covered with a non-stick dressing coated with antibiotic ointment or petroleum jelly. Avoid using adhesive bandages directly on the wound, as they can cause pain and disrupt healing tissue upon removal. Activity restrictions are necessary, including avoiding high-impact activities like running or jumping for at least two weeks. Wearing open-toed shoes or loose-fitting footwear is also recommended to prevent pressure on the sensitive digit.
The soft tissue of the nail bed typically heals within two to four weeks, but new nail growth takes much longer. If the matrix was not permanently destroyed, a fingernail may take four to five months to fully regrow. A toenail grows slower, taking six to twelve months, or up to eighteen months, to completely regenerate. The newly exposed nail bed will remain sensitive and requires continued protection during this entire healing period.
Identifying Signs of Complications
While the procedure is generally safe, patients should watch for specific symptoms suggesting abnormal healing or complications like infection. Mild redness and a slight amount of clear yellow drainage are expected during the first few weeks. However, spreading redness, excessive warmth extending from the wound, increased swelling, or thick, discolored discharge (pus) strongly indicate a bacterial infection.
Seek immediate medical advice if you experience any of the following serious complications:
- Intractable pain not relieved by elevation or standard doses of pain medication.
- A fever, especially when accompanied by chills, which is a systemic sign of a spreading infection.
- The appearance of a new nail spicule or edge regrowing, indicating recurrence after a permanent matrixectomy.
- Bleeding that soaks through the dressing and does not stop after applying firm pressure for twenty minutes.