: Nail Avulsion | FAQ
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 indications for performing nail avulsion are to treat ingrown toenails; to excise tumors of the nail unit; to allow full examination and exploration of the nail bed, or to use as a preliminary step before performing biopsy on the nail bed.
Avulsion of the nail plate is frequently used as a therapeutic adjunct in correcting severe deformities of nail fungus 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.
A partial or complete nail avulsion can be performed, depending on location and extent of disease. Before avulsion, anesthesia of the digit is achieved through a digital block performed with 1-2% lidocaine.
The nail plate is separated from its attachments with a nail splitter. Next, the nail is cut with a nail cutter if it is a partial nail removal, the hemostat clamp is used to gently remove the nail plate. The patient is instructed to perform dressing or band-aid changes twice daily for 2-3 weeks. Matricectomy has a success rate of 95% and higher, and postoperative complication is minimal. However, the associated risks of performing this procedure include pain, frequent recurrence, infection, unpredictable persistent wound drainage, and extended healing times.
The nail matrix is the germinative cellls that forms the nail plate. Matricectomy is the process of surgically, chemically, or electrically ablating or destroying the nail matrix. We use the radiofrequency (RF) device to perform ablative matricectomy. Partial or complete excision of the viable nail matrix results in loss of the nail plate. Therefore, a new nail plate cannot be regenerated.
The most common indications for performing matricectomy are ingrown nails and chronic nail dystrophies that are unresponsive to aggressive non-surgical therapy.
