II. Preparation

  1. Prepare site
    1. Immerse digit in warm soapy water for 10-15 minutes
    2. Prepare area with betadine or hibbiclens
  2. Digital Block anesthesia
  3. Consider Tourniquet (brief application only)
    1. Apply penrose drain or Rubber band at base of digit
    2. Reduces bleeding during procedure
  4. Drape area

III. Technique: Toenail Removal

  1. Check for adequate anesthesia
  2. Elevate nail from nail bed
    1. Use nail elevator (periosteal elevator)
    2. Alternative instruments
      1. Closed tip of iris scissors
      2. English nail anvil
    3. Insert under cuticle and nail fold
  3. Identify line to cut nail
    1. Partial Nail Avulsion
      1. Lateral 1/4 of nail (where nail curves down)
      2. Offers similar outcomes to complete nail excision
    2. Complete Nail Avulsion: Midline of nail
  4. Use nail splitter of sterile bandage scissors
    1. Cut nail to proximal nail fold
  5. Grasp nail with hemostat
    1. Twist lateral fragment outward to remove

IV. Technique: Phenolization for matricectomy (Chemical nail ablation)

  1. Background
    1. Chemically destroy nail matrix
  2. Indications
    1. Indicated for recurrent Ingrown Nail
  3. Efficacy
    1. Phenolization is at least as effective as surgical method
    2. Gerritsma-Bleeker (2002) Arch Surg 137(3): 320-5 [PubMed]
  4. Adverse Effects
    1. Minor increased risk of infection with phenolization (prophylactic antibiotics not recommended)
  5. Contraindications
    1. Do not use phenol in the presence of a pregnant patient or pregnant medical staff
    2. Peripheral Vascular Disease (relative contraindication)
    3. Uncontrolled Diabetes Mellitus (relative contraindication)
  6. Technique
    1. Phenolization uses phenol 80-88%
    2. Apply Phenol with cotton swab to matrix for 30 seconds each, and repeat 3 times
    3. Thoroughly rinse with 70% Isopropyl Alcohol or saline to wash away residual phenol
    4. Only apply phenol to nail matrix and not to nail bed or surrounding tissue
    5. Thoroughly cleanse with Isopropyl Alcohol 70% (neutralizes phenol)

V. Technique: Surgical Matrixectomy (nail ablation)

  1. See Phenolization above for indications
  2. Laser Method
  3. Electrosurgical method (Ellman Surgitron)
    1. Antenna lead placed beneath heel of foot
    2. Clean surgical field of any blood
    3. Flat matricectomy electrode (coated on one side)
      1. Place under nail fold (teflon side facing up)
    4. Apply cautery to each exposed area
      1. Set current to 2 (20 W) of coagulation
      2. Apply current for 5 seconds
      3. Allow to cool for 15 seconds
      4. Repeat application of 5 seconds of current

VI. Technique: Dressing

  1. Apply Vaseline Gauze and tube pressure dressing
    1. Previously antibiotic ointment (e.g. Bacitracin) was recommended as part of initial dressing

VII. Management: Home Instructions

  1. Keep foot elevated for first 24 hours
  2. Change dressing in 24 hours
  3. Topical preparations
    1. No topical agents have been shown to reduce infection or pain, or improve healing
      1. Tried preparations include Topical Antibiotics, antiseptic, manuka honey and paraffin preparations
  4. Antibiotics
    1. Localized inflammation or infection typically resolves after nail removal without antibiotics
    2. Oral or Topical Antibiotics are not indicated unless there is clear and widespread associated Cellulitis
    3. Previously, daily antibiotic ointment (e.g. Bacitracin) was applied until healed
      1. Instead, apply Vaseline Gauze and clear bandage to area daily for 1-3 weeks
  5. Water exposure is controversial
    1. Some recommend only showering, but no soakings
    2. Others soak foot in warm soapy water 2-4 times daily for 4-7 days
  6. Avoid Trauma to toe for first 2 weeks
    1. Wear loose-fitting shoes
    2. Avoid Running, jumping or other potential injury
  7. Observe for signs of infection (Paronychia)

VIII. References

  1. Mandracchia (July, 1998) Hospital Medicine, p. 36-43
  2. Peggs in Pfenninger (1994) Procedures, Mosby, p. 28-43
  3. Heidelbaugh (2009) Am Fam Physician 79(4): 303-12 [PubMed]
  4. Mayeaux (2019) Am Fam Physician 100(3): 158-64 [PubMed]
  5. Zuber (2002) Am Fam Physician 65(2):2547-58 [PubMed]

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Onychectomy (C0191722)

Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 123211006, 386018007, 265698006, 177742003, 177736002, 183668008, 182700002
CPT 11750
English Excision of nail NOS, Avulsion of nail, NOS, Nail ablation, Nail removal NOS, Removal of nail, NOS, ablation nail, nail removal, onychectomy, nail avulsion, nail excision, total nail avulsion, Removal of nail plate, Excision of nail NOS (procedure), Avulsion of nail (procedure), Nail avulsion, Avulsion of nail, Excision of nail, Excision of nail (procedure), Removal of nail (procedure), Removal of nail plate (procedure), Removal of nail, Avulsion of nail -RETIRED-, Onychectomy
Italian Avulsione dell'unghia, Rimozione di unghia, Rimozione di unghia NAS
Dutch nagel loslating, nagelverwijdering NAO, nagel avulsie
French Ablation d'un ongle, Ablation d'un ongle SAI, Avulsion unguéale
German Nagelabtragung, Nagelentfernung NNB, Nagelentfernung
Portuguese Extracção de unha NE, Ablação de unha, Avulsão das unhas
Spanish Ablación de uña, Extirpación de uña NEOM, resección ungueal, SAI (procedimiento), resección de uña, SAI, avulsión de una uña - RETIRADO - (concepto no activo), avulsión de una uña - RETIRADO -, resección ungueal, SAI, remoción de lámina ungueal (procedimiento), remoción de lámina ungueal, remoción de uña (procedimiento), remoción de uña, resección de uña (procedimiento), resección de uña, Avulsión de la uña
Japanese 抜爪NOS, 抜爪, 爪裂離, ツメレツリ, バッソウNOS, ソウレツリ, バッソウ
Czech Ablace nehtu, Odstranění nehtu NOS, Avulze nehtu
Hungarian Köröm-ablatio, Körömablatio, Körömeltávolítás k.m.n.

Ontology: Removal of toenail (C0576780)

Concepts Therapeutic or Preventive Procedure (T061)
ICD10 47906-01
SnomedCT 275090004
Dutch verwijdering van teennagel, teennagelverwijdering
French Onycectomie d'orteil, Ablation d'un ongle d'orteil
German Zehennagelentfernung, Entfernung des Zehennagels
Italian Rimozione di unghia del piede, Asportazione di unghia del piede
Portuguese Extracção de unha do pé
Spanish Extirpación de uña del pie, Extirpación de uña de dedo gordo del pie, remoción de uña del pie (procedimiento), remoción de uña del pie
Japanese 足指抜爪, ソクシバッソウ, アシユビバッソウ
English Removal of toe nail, Toe nail removal, removal of toenail, Removal;toenail(s), toenail removal, toe nail removal, removal of toe nail, Removal of toenail, Removal of toenail (procedure), removal of toenails
Czech Odstranění nehtu na noze
Hungarian Lábujjköröm-eltávolítás, Öregujjköröm eltávolítása

Ontology: Wedge resection of ingrown toenail (C0845450)

Concepts Therapeutic or Preventive Procedure (T061)
ICD10 47915-00
English Wedge resection of ingrown toenail

Ontology: Partial resection of ingrown toenail (C0845451)

Concepts Therapeutic or Preventive Procedure (T061)
ICD10 47916-00
English Partial resection of ingrown toenail

Ontology: ingrown toenail resection (C0850556)

Concepts Therapeutic or Preventive Procedure (T061)
English Resection;ingrown toenail(s), ingrown toenail resection, Resection;ingrown toenail

Ontology: Wedge resection toenail (C0852705)

Concepts Therapeutic or Preventive Procedure (T061)
ICD10 1632
SnomedCT 150583001, 266778001
Italian Resezione cuneiforme di unghia del piede
Dutch teennagelwig resectie, wigexcisie teennagel
French Résection cunéiforme d'un ongle d'orteil, Résection d'un ongle incarné d'orteil
Spanish Resección en cuña de una uña de dedo del pie, Resección cuneiforme de uña del pie
Japanese 足指爪楔状切除, ソクシソウケツジョウセツジョ, ソクシソウクサビジョウセツジョ
Czech Klínová resekce nehtu na noze
English Toenail wedge resection, Wedge resection toenail, Excision of toenail, Ingrowing toenail excision, Wedge resection - toenail, Removal - avulsion - of nail, Removal/avulsion of nail, Nail removal - avulsion, Toenail excision, Zadik's nail bed avulsion
Hungarian Ék-resectio lábujjkörmön, Lábujjköröm ék-resectio
Portuguese Corte das unhas dos pés
German Keilresektion des Fussnagels

Ontology: Matrixectomy (C3544077)

Concepts Therapeutic or Preventive Procedure (T061)
English Matrixectomy, Matricectomy
Czech Matrixectomie
Dutch matrixectomie, matricectomie
French Matricectomie
German Matrixektomie
Hungarian Matrixectomia, Matricectomia
Italian Matricectomia
Japanese ソウショウセツジョ, 爪床切除
Portuguese Matricectomia
Spanish Matricectomía