10% of the patients who visit dermatologist seek consultation for nail related disorders .A proper and successful nail surgery needs a thorough understanding and knowledge of all congenital problems , infectious and inflammatory process related to nail disease , Tumors, and also the most common cause reason for nail disorder i.e., trauma to nail . The main objective of nail surgery is to get the patient relief from pain and treat the underlying infection and to correct or rectify the anatomical deformity and also to expose the underneath anatomical delineation, for biopsy or excision.
Before a dermatologist begins with the surgical procedure a proper history and clinical evaluation is done by dermatologist which include any medical illness, previous nail surgery, drug allergies and medications if a patient is taking .Diabetes mellitus, peripheral vascular diseases, Steroid or blood thinner is important consideration before planning a nail surgery.
Patients are apprehensive about the pain during the surgery and hence a local anaesthesia injection is done before a Nail surgery .Sometimes a nerve block distal or proximal digital nerve block is also given according to the need by dermatologist.
The purpose of nail avulsion is to expose the nail bed and matrix in order to perform matricectomy or bed or matrix biopsy and also to treat fungal infection, candidiasis , ingrown toe nail and also for pain relief in case of hematomas .
The nail is either removed partially or completely .In partial avulsion a longitudinal strip of the nail is removed from the adjacent structures and is mostly used for ingrown toe nail and the total nail avulsion is in which entire nail plate is removed. Nail surgery in cases of warts involvement may need surgical intervention. An electrosurgery unit or a radiofrequency machine may be used for this purpose . A carbon dioxide laser for verruca vaporisation is also a treatment option for nail surgery .
The needed bandaging is done after the control of bleeding and thorough debridement of the surgical area . Strict asepsis is neede for nail surgery and the cost of nail surgery is dependent on which kind of instrumentation is used for nail plate removal. Laser nail avulsion is costlier as compared to cautery surgery .Nail surgery post operative care and regular dressing is needed for proper healing of nail bed and surrounding structures and to reduce post operative pain and complications. A 7-10 day antibiotic course may be needed by the patient after the nail surgery.
Nail Surgery success depends on the operative procedure, post operative care and dressing, sugar and blood pressure care and control and proper dressing care after the surgery and to follow the instructions given by treating dermatologist . Ingrowing toe nail is the most common cause by tight fitting shoes and chappals or any other foot wear which may be prevented if proper care and proper size and shape selection of the footwear and its comfort is given priority.
Patients should avoid exposing the nail to harsh detergents , wearing cotton socks and to clean the nail and surrounding skin with a antiseptic cream and to use nail lacquer in case of brittle nails along with proper diet supplements or vitamin intakes if needed. While washing clothes try to wear protective nail or finger covering or if possible use gloves and other recommended care by the doctor to occurrence or nail disesaes recurrence. Patients are advised to trim the nail regularly and in case of fungal infection get it treated by dermatologist because it may infect nail ‘ s surrounding skin and other nails also.
Infected nails due to fungal infection or nail involvement due to psoriasis. Lichen planus etc. Needs care for the existing diseases along with the nail treatment/ surgery . Sometimes intralesional injections may be needed at the periphery of the nail so as to get proper nail . Multiple nail involvement or wart involvement along with nail may need multiple sittings and nail avulsion procedure for desired results .
Nail being exposed to environmental hazards and harsh weather needs proper care . Corns involvement may also involve the nail , in such cases corn as well as the nail may need surgical removal or treatment Dark / Fungal infected nail may need antibiotic and long term oral anti fungal drugs for best results along with underlying systemic diseases .