Nail surgery is a specialized, minor medical procedure performed primarily by podiatrists or dermatologists to treat underlying structural or pathological issues of the nail unit. The nail unit includes the nail plate, the nail bed beneath it, the nail matrix where the nail grows from, and the surrounding soft tissue folds. This procedure is performed to resolve medical problems that have not responded to non-surgical treatments, rather than for cosmetic reasons. Nail surgery aims to provide long-term relief from pain, recurring infection, or structural deformity.
Conditions Requiring Nail Surgery
Surgery is reserved for persistent or severe nail issues where conservative methods have failed to provide a lasting resolution. The most common indication is chronic or recurrent onychocryptosis, commonly known as an ingrown toenail, especially when the nail edge is deeply embedded or accompanied by infection. This condition causes pain, inflammation, and sometimes a severe infection that requires immediate removal of the offending nail portion.
Other conditions involve structural abnormalities or the presence of lesions that threaten the health of the digit. Nail surgery is often necessary for the diagnosis and removal of tumors, cysts, or suspicious lesions underneath or around the nail, such as a glomus tumor or subungual exostosis. A diagnostic nail biopsy, where a small tissue sample is taken from the nail bed or matrix, is often required to accurately identify conditions like fungal infections, psoriasis, or potential malignancies like subungual melanoma.
Severe or chronic infections resistant to oral or topical medications may also necessitate surgical intervention. For instance, advanced onychomycosis, or fungal nail infection, can cause the nail to become excessively thick and deformed, sometimes requiring total nail removal to facilitate effective topical treatment or prevent pain. Significant trauma resulting in a lacerated nail bed or a large subungual hematoma (blood under the nail) may require surgical repair to prevent permanent nail deformity.
Overview of Common Surgical Approaches
Nail surgery is performed as an outpatient procedure under local anesthesia, typically a digital block injected into the base of the digit. A tourniquet, a tight rubber band placed around the toe, is often applied to create a bloodless surgical field. This allows for precise removal of the problematic tissue and application of any necessary chemicals.
One of the most frequent surgical techniques is a partial nail avulsion, where only the problematic side portion of the nail is removed, leaving the rest of the nail plate intact. This is often combined with a matrixectomy, which is the permanent destruction or removal of the corresponding section of the nail matrix, the tissue that grows the nail. Chemical destruction, most commonly using phenol, is the preferred matrixectomy method for chronic ingrown nails, as it cauterizes the root tissue to prevent future regrowth of the spicule.
For conditions like severe tumors or widespread infection, a total nail avulsion may be performed, involving the complete removal of the entire nail plate. If pathology requires a diagnostic sample, a nail biopsy is performed, taking a small segment of the nail bed or matrix for laboratory analysis. When trauma has damaged underlying structures, a nail bed repair procedure involves carefully suturing the lacerated tissue to realign the nail-growing surface.
Post-Procedure Care and Recovery
Following the procedure, a bulky dressing is applied to protect the surgical site and manage any initial bleeding. Patients are advised to rest and keep the foot elevated for the first 24 to 48 hours to minimize swelling and throbbing pain. Discomfort is usually managed effectively with over-the-counter pain relievers, such as acetaminophen, after the local anesthetic wears off.
Instructions for dressing changes are provided, often involving keeping the site dry for the first day and then changing the dressing every few days. Open-toed footwear is recommended until the initial bulky dressing is removed to avoid pressure on the healing area. The full healing timeline varies; a simple biopsy may heal in a couple of weeks, while a matrixectomy often requires six to twelve weeks for the nail bed to fully skin over.
During the healing phase, a yellowish discharge from the surgical site is common, particularly if a chemical agent like phenol was used, and this does not necessarily indicate an infection. Patients should monitor for signs requiring immediate medical attention, such as a high fever, severe pain unresponsive to medication, or excessive redness and swelling rapidly spreading away from the surgical site. Avoiding strenuous activity, swimming, and tight footwear is necessary until the wound has completely healed.