The loosing nails or nail deformities may require partial or whole nail removal. These nail deformities can occur secondary to anything that causes injury or deformation of the nail bed. This may include infection, tumor, or trauma. The common diseases with nail deformities includes onychocryptosis (ingrown nail), onychogryposis (deformed, curved nail), onychomycosis (nail fungus), chronic recurrent paronychia. Nail bed biopsy is a common diagnostic surgical procedure for the mass lesion or pigmented bands under the nail. Nail bed repair is often needed to repair the traumatized finger nails.
The preoperative evaluation before nail surgery includes a medical history and a physical examination. In the presence of active infection, all elective nail procedures are better deferred until the infection is appropriately managed with antibiotic coverage and soaks. In clinical presentations, such as painful ingrown toenails, postponement of surgery may not be an option. The patient should discontinue all anticoagulants, including Aspirin products, 1 week before surgery. The surgeon will discuss the potential risks and benefits of the surgical procedure to be performed, anesthesia, the expected healing time, the potential postsurgical complications, and the possibility of long-term structural or functional deformity of the nail.
A digital nerve block or ring block with 1% or 2% Lidocaine is best used for nail surgery. Lidocaine has an almost immediate onset and an anesthetic effect lasting 1-2. A tiny 30-gauge needle is used to inject Lidocaine in both sides of finger or toe. Anesthesia becomes effective in approximately 5-10 minutes.