11750 Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal

Name of the Procedure:

Excision of nail and nail matrix, partial or complete (e.g., ingrown or deformed nail), for permanent removal

• Commonly referred to as "nail avulsion" or "partial/total nail removal"

Summary

The procedure involves surgically removing part or all of a problematic nail and its underlying matrix (the tissue that produces the nail). This is performed to treat conditions such as ingrown or deformed nails and aims to provide a permanent solution by preventing regrowth of the problematic nail portion.

Purpose

The procedure addresses:

• Conditions like ingrown toenails, fungal infections, or nail deformities.
• The primary goal is to provide relief from pain, infection, and other symptoms associated with the problematic nail.

Indications

• Recurring ingrown toenails causing pain and infection.
• Nail deformities that interfere with daily activities.
• Severe fungal nail infections unresponsive to other treatments.
• Patients with persistent nail bed infections or trauma.

Preparation

• Patients may need to avoid eating for a few hours before the procedure.
• Adjustments in medications, such as blood thinners, may be necessary.
• Pre-procedure assessment includes checking for allergies, especially to anesthetics.

Procedure Description

1. The patient is positioned comfortably, usually with their foot or hand elevated.
2. Local anesthesia is administered to numb the affected area.
3. The surgeon uses specialized tools to separate and remove the problematic nail and its matrix.
4. The wound is then cleaned, and an antiseptic dressing is applied.
   • Tools: Sterile scissors, forceps, cutters, and possibly a phenol solution for ensuring permanent removal.
   • Sedation: Primarily local anesthesia.

Duration

The procedure typically takes about 30 to 45 minutes.

Setting

• Usually performed in an outpatient clinic, podiatrist's office, or a minor surgical suite.

Personnel

• Involves a surgeon or podiatrist.
• Support from a nurse or medical assistant is common.

Risks and Complications

• Common: Pain, swelling, and minor bleeding.
• Rare: Infection, reaction to anesthesia, prolonged healing, regrowth of the nail.

Benefits

• Relief from pain and recurring issues caused by the problematic nail.
• Permanent solution, often realized within a few weeks post-procedure.

Recovery

• Post-procedure care includes keeping the area clean and dry, applying prescribed ointments, and taking pain medications as directed.
• Patients may need to avoid strenuous activities and wear open-toed shoes or loose gloves initially.
• Full recovery generally occurs within 2 to 4 weeks, with follow-up appointments scheduled as needed.

Alternatives

• Conservative treatments like soaking, proper nail trimming, and topical medications.
• Partial nail removal without matrix destruction.
• Pros: Less invasive, preserves nail appearance.
• Cons: Higher chance of recurrence.

Patient Experience

• During: Little to no pain due to local anesthesia, some pressure sensations.
• After: Mild to moderate pain manageable with prescribed pain medications, mild discomfort, and swelling.
• Comfort measures: Keeping the foot or hand elevated, using ice packs, and following all post-care instructions.